Road Traffic Accident Claim

Please register your claim below and book your appointment online.

The details you provide will then be considered by a senior solicitor and your appointment will be confirmed. If for any reason we are unable to proceed with your claim, you will be notified immediately and the appointment will be cancelled.

We will endeavour to contact you and confirm your appointment within 4 working hours of receipt.

Browell Smith & Co Solicitors
Free Consultation, No Obligation, 100% Compensation

Your Name

Address

City/Town

County

Postcode

Date of birth

Date of Birth :: Please enter the date in the format DD/MM/YYYY

NI Number

National Insurance Number :: If you can't remember your number, you may find it on official paperwork, eg;
- your end of year tax statement (P60)
- a payslip
- a copy of your annual tax return
Otherwise, contact your local Jobcentre Plus, social security office or HM Revenue & Customs (HMRC) NI Contributions Office.

Telephone No.

Email

Email :: Please enter a valid email address e.g. yourname@service.com

Browell Smith & Co Solicitors
Free Consultation, No Obligation, 100% Compensation

Your involvement in the accident select... Driver Passenger Pedestrian Cyclist Motorcyclist Bus Passenger Other

Date of accident day... 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 month... January February March April May June July August September October November December year... Before 2007 2007 2008 2009 2010 2011 2012

If yes, please provide name

How did it happen?
(very briefly)

Type of injury

Where did you receive medical treatment, if any?

Accident Treatment :: e.g. GP, Hospital

Please name who you believe is to blame

Their address if known

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Was your vehicle damaged?

Yes No

Do you require assistance completing insurance forms? Yes No

Do you require your vehicle collecting and repairing? Yes No

Do you require a replacement vehicle? Yes No

ALL FREE OF CHARGE (subject to merit)

Do your symptoms persist? Yes No

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Arrange an appointment online?

Yes No

Would you prefer a home visit?

Yes No

(Limited home visits are also available on a Saturday)

Please select your preferred home visit date

Home visit date

 

Browell Smith & Co Solicitors
Free Consultation, No Obligation, 100% Compensation

Source Choose Option Television Advert Radio Advert Newspaper Advert (please specify) Union Referral (please specify) Yellow Pages Mail Shot Respondent Recommendation Former/Existing Client (quote reference) Internet (please specify website/search engine) Other (please specify)

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Click to submit your application