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Case Details
Case Type
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Client Status
*
Was the client a passenger in the defendants vehicle?
Yes
No
*
Please select if the client was a passenger in the defendants vehicle?
Client Details
Personal Detail
Title
*
Male
Female
*
Forename(s)
*
Surname
*
D.O.B
April 2021
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Today
Clear
Please enter the Date of Birth
National Insurance
Either the NI Number or Reason NI Number not available must be entered
NI Number
Reason NI number not available
Address
House ID
*
Street 1/2
*
District
Town/Country
*
Postcode
Lookup Address
Contact Details
Home Tel
Work Tel
Mobile
*
Email
Invalid value
Employment
Employment Status
*
Occupation
*
Litigation Friend Details
Personal Detail
Title
*
Male
Female
*
Forename(s)
*
Surname
*
Address
House ID
*
Street 1/2
*
District
Town/Country
*
Postcode
Client Notes
Please enter required values
Confirmation
Username:
OK
Defendant Details
Personal Detail
Details unknown at present
Male
Female
*
Title
*
Forename(s)
*
Surname
*
D.O.B
April 2021
Mon
Tue
Wed
Thu
Fri
Sat
Sun
13
29
30
31
1
2
3
4
14
5
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9
Jan
Feb
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Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Today
Clear
Address
House ID
*
Street 1/2
*
District
Town/Country
*
Postcode
Lookup Address
Contact Details
Home Tel
Work Tel
Mobile
Email
Invalid value
Defendant Insurance Details
Please provide the Name, Address and contact details of the Insurance Company
*
Defendant Notes
Please enter required values
Confirmation
Username:
OK
Defendant Vehicle
Defendant's Vehicle Details
Registration
*
Make
*
Model
*
Colour
*
Defendant Vehicle Damage
Registered Keeper / Driver Details
Defendant is Registered Keeper
Personal Detail
Title
*
Male
Female
*
Forename(s)
*
Surname
*
Address
House ID
*
Street 1/2
*
District
Town/Country
*
Postcode
Defendant is Vehicle Driver
Personal Detail
Title
*
Male
Female
*
Forename(s)
*
Surname
*
Address
House ID
*
Street 1/2
*
District
Town/Country
*
Postcode
Please enter required values
Add Another Defendant?
Click on the + Icon to add another defendant to the case or click the Next Step button to continue adding the case
Accident Details
Accident Detail
Accident Date
April 2021
Mon
Tue
Wed
Thu
Fri
Sat
Sun
13
29
30
31
1
2
3
4
14
5
6
7
8
9
10
11
15
12
13
14
15
16
17
18
16
19
20
21
22
23
24
25
17
26
27
28
29
30
1
2
18
3
4
5
6
7
8
9
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Today
Clear
Please enter the Incident Date
Accident Time
Please enter the accident time
Location
Please enter the accident location
Nearest Town
Please enter the nearest town
View Location Map
Accident Classification
Hit by party emerging from side road
Hit in the Rear
Hit whilst Parked
Concertina Collision
Accident in a Car Park
Accident on a roundabout
Accident invoving vehicles changing lanes
Other
At least one Accident Classification sholud be checked or fill other classification
Was Accident reported to the police ?
Yes
No
Was the client wearing a seatbelt ?
Yes
No
Not Supplied
* Was the client wearing a seatbelt?
Did the accident involve a bus/coach ?