Road Traffic Accident Enquiry

L A Steel Solicitors — complete the sections you can; we will contact you to arrange your free half-hour interview.

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Your details

Your name

Email address (required)

Residential address

Home telephone number

Work telephone number (used only in emergencies)

Date of birth

Your vehicle and insurance

National Insurance number

Date of accident

Place of accident

What vehicle were you driving?

Who are your own insurers?

Type of cover (e.g. third party, fire & theft, fully comprehensive)

Policy number

Other party’s details

Other party’s name

Other party’s address

What sort of vehicle was the other person driving (if known)?

Registration of his/her vehicle (if known)

Who are the other person’s insurers (if known)?

Address of the other person’s insurers (if known)

Accident details

On what date did the accident happen?

Approximately what time did the accident happen?

Where did the accident happen? (road name and area)

Were there any witnesses to the accident?

If so, please provide their names and addresses

Please provide a brief description of how the accident happened

Other losses

Are you employed?

If so, details of your employers (if self-employed, your accountant’s details)

Have you suffered any loss of earnings?

Approximately what amount?

Did you attend hospital?

If so, which one?

Details of your GP

Have you obtained quotes for the repair of your vehicle, or is it a ‘write-off’?

If the vehicle can be repaired, details of the repairing garage

Where is the vehicle currently stored?

Are there any charges involved for its storage?

Thank you for taking the time to complete this form.

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