Online Claim Form


Title

Name*

Email*

Telephone*

Best Time to Call*

Mobile

Type of accident*

When did the accident occur?*

Have you visited your GP/hospital?*

Brief description of accident*

* denotes mandatory field

FSA Registered Number 314773. Authorised and regulated by the Financial Services Authority in respect of Insurance Mediation activities only.
Authorised by the Ministry of Justice under the Compensation Act 2006, to provide Claims Management Services for Personal Injury:
Authorisation Number: CRM 2350. Complete Accident Solutions (UK) Ltd is regulated by the Ministry of Justice in respect of regulated claims management activity; its registration is recorded on the web site www.claimsregulation.gov.uk.

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