Online Claim Form

Please complete the short form below for a free, no-obligation assessment of your claim. We will deal with your enquiry promptly and in complete confidence. Alternatively simply call our freephone helpline on 0800 0511 511

Compensation Claim Form

Title
Full name

Address (optional)

Telephone

Mobile telephone
Email
Date of accident
Type of accident

Brief description of accident and injury

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Accident Compensation Helpline Ltd is regulated by the Ministry of Justice and is authorised to undertake regulated claims management activities under the provisions of the Compensation Act 2006, our authorisation number is CRM2236 and our registration is recorded on the Ministry of Justice website www.claimsregulation.gov.uk * Charges may be applicable in exceptional circumstances. Solicitors terms and conditions apply.
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