Claim Online

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Fields marked with a * are required.

Name*:

Your title, first name, and last name.

Phone Number*:

Telephone number including the STD Code. Example: 01759 154456.

Alt Phone Number:

Alternative or Mobile phone number.

Accident Type*:

 Road Accident
Work Accident
Slip, Trip or Fall		 Medical Negligence
Accident in Public
Other Accident

Please slecet the types of accident.

Additional Information:

Any additional information you wish to include.
 

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EasyClaimUK is regulated by the ministry of justice in respect of regulated claims management activities. Our CRM number is 7449 and our regulation is recorded on the ministry of justice website; www.claimsregulation.gov.uk