personal-injury-claim-specialist.co.uk

---

---

Start a Personal Injury Claim
* First Name(s)
* Last Name
* Date of Birth	Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990
* Email
* Address
* Postcode
* Home Telephone
Mobile Phone Number
Best time to Call You	Please Select ASAP 9am-10am 10am-11am 11am-12pm 12pm-1pm 1pm-2pm 2pm-3pm 3pm-4pm 4pm-5pm 5pm-6pm 6pm-7pm 7pm-8pm 8pm-9pm
* Date of Accident	Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Accident Location
* Type of accident	Please Select                                       Road traffic accident Accident at work Passenger in a vehicle Trip/slip Work related illness Defective goods injury Injury on holiday Assault/criminal injury Medical/dental negligence Other
* Brief Details of Accident
What injuries have been suffered as a result?
Where there any witnesses?	Please Select Yes No
Have had any previous legal advice?	Please Select No Yes

© 2008 personal-injury-claim-specialist.co.uk. All rights reserved.
Personal Injury Claim Specialist is a trading name of 123 Debt Solutions Ltd. Registered in England and Wales. Company registration number: 6169935. Registered Office: 31 Davenham Court, Childwall, Liverpool, L15 8GD. Regulated by the Ministry of Justice in respect of regulated claims management activities. Registration is recorded on www.claimsregulation.gov.uk. Authorisation No. CRM16139