New Accident Claims

Starting your claim is simple with Brearleys solicitors.  Don't forget it won't cost you a penny either.  Please fill in as much as you can below.  If there is anything you don't know at this stage then don't worry - just leave that box blank.  If you would prefer to speak to someone instead then please call our freephone on 0800 0923422

Your Details

Your name          

 First name                             Last name          

Your Address

            House name / number   

            Street                           

            Town                            

            County                         

            Postcode                      

Your Contact details

            Telephone number - daytime                

            Telephone number - mobile                  

            Email address       

Accident details

            Date of accident

                            Day    eg. "15"            

                            Month eg  "06"             

                            Year    eg  "2007"        

            Type of accident    Please tick one

                                Accident at work   

                                Road traffic accident   

                                Trip or slip in a public place   

                                Accident abroad   

                                Industrial disease   

                                Fatal accident

                                Other

Opponent details   

Please fill in as much as you can about your opponent below   

Opponents Name            

 First name                             Last name          

Company name (where applicable)   

Opponents Address

            House name / number   

            Street                           

            Town                           

            County                         

            Postcode                      

Accident circumstances   

Please set out a brief description of what happened

Injuries sustained   

Please set out below details of your injuries and how long they lasted for (or if still continuing)

Where did you find out about Brearleys Solicitors?

Not selected I have used you before Yellow Pages (Please specify below) Newspaper advert (please specify below) Hull Colour Pages Radio advert TV Advert Internet search engine (please specify below) Saw the office Saw your a-board Leaflet

Thankyou

Please press the submit details button below and it will be directed to us immediately.  We will be in touch straight away if during the day, out of normal office hours you should expect to receive contact the next working day.  If your query is urgent or you want to speak to someone now then please call our freephone on 0800 0923422