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PERSONAL ACCIDENT CLAIM FORM Please return Completed Claim Form and Medical Certificate(s)/ Other evidence to: Perkins Slave Ltd Tricorn House 5153 Harley Road Birmingham B16 8TP 0121 698 8046 Policy
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How to fill out personal accident claim form
How to fill out a personal accident claim form:
01
Start by entering your personal information at the top of the form. This includes your full name, address, phone number, and email address.
02
Next, provide details about the accident. Specify the date, time, and location of the incident. Describe what happened and how it occurred in clear and concise language.
03
Include information about any witnesses to the accident. Provide their names, contact details, and a brief description of their involvement or what they witnessed.
04
Proceed to fill out the section regarding your injuries. Describe each injury sustained in detail, including the body part affected and the severity of the injury.
05
If applicable, provide information related to medical treatment received. Include the names of the healthcare professionals or facilities involved, along with any prescriptions or medications prescribed.
06
Indicate whether you have any pre-existing medical conditions that may have been impacted by the accident. Provide details of these conditions and any changes you experienced as a result of the incident.
07
If applicable, fill out the section on lost wages or income. Specify the dates missed from work and calculate the amount of income lost during that period.
08
Attach any supporting documents, such as medical reports, police reports, or photographs of the accident scene. These documents can strengthen your claim and support your narrative.
09
Finally, review the completed form for accuracy and completeness. Make sure all the required fields are filled out correctly, and sign and date the form before submitting it to the relevant party.
Who needs a personal accident claim form?
Any individual who has been involved in an accident and wishes to seek compensation for their injuries or damages may need to fill out a personal accident claim form. This form is typically required by insurance companies, employers, or legal authorities to initiate the claims process. It allows claimants to provide detailed information about the accident, injuries sustained, and any related expenses or losses. By filling out this form, individuals can present a comprehensive case to support their claim and increase their chances of receiving appropriate compensation.
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What is personal accident claim form?
The personal accident claim form is a document used to report an accident that resulted in personal injury.
Who is required to file personal accident claim form?
Anyone who has been involved in a personal accident and suffered injuries is required to file a personal accident claim form.
How to fill out personal accident claim form?
To fill out a personal accident claim form, you need to provide details about the accident, your injuries, medical treatment received, and any other relevant information.
What is the purpose of personal accident claim form?
The purpose of the personal accident claim form is to report the details of the accident and injuries sustained in order to seek compensation.
What information must be reported on personal accident claim form?
Information that must be reported on the personal accident claim form includes details of the accident, injuries sustained, medical treatment received, and any other relevant information.
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