Insurance Claim

This claim form MUST be completed in full. Failure to fully complete this form may result in your claim being delayed.

  Claimant Details   


  Details of the Incident   

  Other Information relating to the Incident   

  Property Damage   

Please remember to attach any receipts and/or repair estimates with this form. Also please be sure to include the vehicle make, model and registration number if your vehicle was damaged.

  Your Insurer's Details   


If you suffered an injury as a result of the incident the council and it's claims and legal agents have a duty to advise the Department of Work and Pensions (Compensation Recovery Unit) you have submitted a claim for compensation. To ensure we only pass on the correct information, you must provide all the relevent information requested.