Claim – Complete Accident Solutions

Vehicle Damage Claim Form

We just need to take some details about you, the other parties involved and the accident circumstances to start your claim for vehicle damages. We deal direct with the other sides insurers to protect your no claims. Please provide as much detail as you can as this will help to speed up your claim.

Your Details

Are you claiming for yourself or a company?
- Individual Claim
- Company Claim
Company Name
Your Name*
Title
Mr
Mrs
Miss
Ms
Dr
Prof.
Rev.
First

Last
Date of Birth
Phone Number
Email

Email
Are You VAT Registered
- Yes
- No
VAT Number
Address*

Street Address

Address Line 2

City

Post Code
Your Vehicle Details
Vehicle Registration
Vehicle Make
Vehicle Model
Are you the registered keeper of the vehicle?
Is the vehicle registered to you with the DVLA
Registered Keepers Name*
Title
Mr
Mrs
Miss
Ms
Dr
Prof.
Rev.
First

Last
Registered Keepers Address

Street Address

Address Line 2

City

Post Code
Registered Keepers Phone
Registered Keepers D.O.B
Accident Details

Accident Date?
Vehicle Damage*
Select the areas on your vehicle where there is damage caused by the accident

You can select more than one area of damage.
- Front Damage
- Nearside Left Front Damage
- Offside Right Front Damage
- Nearside (Left) Damage
- Rear Damage
- Nearside Left Rear Damage
- Offside Right Rear Damage
- Offside (Right) Damage
Accident Location
Accident Details*
Please provide details of what actually happened in the accident?

Accident Details
Accident Time?
Please provide the approximate time of the accident

: HH

MM
Were there any witnesses to the accident?
Did the police attend the accident?
Witness Details
Please provide details of any witnesses to the accident
Use the + to add another witness.
Witness Name Witness Telephone Number
Police Details
Please provide police details
Police Officer Reference Number
Weather Conditions
At the time of the accident
Road Conditions
At the time of the accident
Has the other driver admitted liability for the accident?
Did the other driver admit they were at fault for the accident.
Accident Pictures
Please upload any pictures you have of the vehicle damage, the accident scene, and the other vehicle(s) involved including the other vehicle's registration plate.
Drop files here or
Third Party Details
The Other Person Involved in the Accident

Vehicle Registration
Vehicle Make
Vehicle Model
Drivers Name

First

Last
Was the driver male or female?
- Male
- Female
- Unknown
Phone
Is the vehicle a works vehicle?
i.e a bus, lorry, van or car with company decals?
Company Name
Company Phone Number
Address

Street Address

Address Line 2

City

Postcode
Do you have the other parties insurance details?
It's ok if you didn't get the details
Insurer
Policy Reference
Insurer Phone Number
Sign & Submit

Did you get injured in the accident, are you considering a claim for personal injury?
Our claims solicitors are experts at handling road accident injury compensation claims.
More info on Personal Injury Claims
Consent*
The information you’ve given us will be used to complete a Claim Form that we will send to the other driver’s insurance company to start your claim. I am required to tell you that you have 14 days to cancel our services however it is important that we register your claim immediately are you happy for Complete Accident Solutions to start work on your claim straight away?
I agree to start my claim straight away.
GDPR*
I consent to my submitted data being collected and stored. Please refer to our Terms & Conditions for more information.
I consent
Signature
Email
This field is for validation purposes and should be left unchanged.

Data Security

We Treat Your Data With Care

We take our data management responsibilities seriously at Complete Accident Solutions so you can be confident that all data we collect will be used, stored and managed in accordance with current GDPR regulations.

Vehicle Damage Claim Form

Your Details

Your Vehicle Details

Accident Details

Third Party Details

Sign & Submit

Data Security

We Treat Your Data With Care

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Support

Complete Accident Solutions is authorised and regulated by the Financial Conduct Authority; No: 833512

01792 341 069

Request a Callback

We'll only use your number to call you back

info@cascar.co.uk

Witness Name	Witness Telephone Number

Police Officer	Reference Number