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PUBLIC LIABILITY CLAIM FORM All questions must be answered fully ticks and dashes are not acceptable NAME OF INSURED. FULL ADDRESS.. TEL No.. POLICY No.. BUSINESS OR OCCUPATION. WHEN WHERE DID THE ACCIDENT OCCUR a Date. DO YOU THINK YOU ARE LEGALLY LIABLE YES/NO. 10. ARE THERE ANY OTHER INSURANCES COVERING THIS ACCIDENT YES/NO. c Place. EXPLAIN FULLY HOW THE ACCIDENT OCCURRED. GIVE NAMES AND ADDRESSES OF WITNESSES IF ANY a WAS THE ACCIDENT REPORTED TO THE POLICE YES/NO. b IF YES NAME OF...

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All questions must be related to the specific topic or subject at hand.

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