Accident Compensation Claim Form - Child Injuries

To make a claim for compensation please complete our accident compensation claim form. Alternatively, you can request a call back and speak to one of our accident advisors.

Your Details

Your Name

Email Address

Phone number

Your Child's Details

Child's Name

Sex

Child's Date of Birth

Incident Details

Date of Accident

Please give a brief description of your child's accident, including the location.

Extent of Injuries

Please give a brief description of the injuries your child sustained due to the accident.

Did your child see his/her GP?

Other Relevant Information

Were there any witnesses to your child's accident?

Please state below the best time to contact you, and by which method. Also, you may use this box for any other comments or questions you may have.

The information submitted on this accident compensation claim form will be treated with strict confidentiality. It will not be used for any purpose other than assessing your claim for injury compensation.

Security code

Send a copy to my own email address

REQUEST A CALLBACK

Accident Compensation Claim Form - Child Injuries

Contact Us

Accident Types

Useful Links

About Us