HBJ Gateley Wareing

Injured Party

	General information regarding Making a Claim
	Making a Claim

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Making a Claim

If you wish to pursue a claim using the professional services of HBJ Gateley Wareing Claim Solutions, please complete the following form. Please note that all of the sections marked with a red asterisk must be completed before your form can be processed. Should you require further information prior to submitting your claim, please contact the following senior members of our team.

John Lawrie, Business Development Director; Tel: 0131 222 2400
Email: JLawrie@hbj-gw.com

Colin Ludwig, Claims Director; Tel: 0141 248 1124
Email: CLudwig@hbj-gw.com

* name:

.* postal address:

.* post code:

* e-mail address:

* home telephone no.:
(incl STD code)

* work telephone no.:
(incl STD code)

. date of birth:

. vat registered:

yes

._accident particulars

.* date of accident:

* location of accident:

* was the accident reported to the police?

yes

. were there witnesses (including passengers)?

yes

. is witness 1 a passenger?

passenger

. independent witness

. is witness 2 a passenger?

passenger

. independent witness

. is witness 3 a passenger?

passenger

. independent witness

_third party particulars

* name:

.* postal address:

.* post code:

.home telephone no.:
(incl STD code)

.work telephone no.:
(incl STD code)

._accident description

* please provide a full account of the accident circumstances:

._uninsured losses

.* please tick the items below that you wish to claim for, and enter the amount in the appropriate box (£):

. (1) Policy Excess
.(Policy Excess Amount:)

. (2) Repair Costs
.(Repair Costs Amount:)

. (3) Hire
.(Hire Amount:)

. (4) Travelling Expenses
(Travelling Expenses Amount:)

. (5) Loss of Use
.(Loss of Use Amount:)

. (6) General Inconvenience
.(General Inconvenience Amount:)

. (7) Damaged Clothing
(Damaged Clothing Amount:)

. (8) Damaged Personal Effects.
(Damaged Personal Effects Amount:)

. (9) Personal Injury.
(Personal Injury Amount:)

. (10) Loss of Earnings.
(Loss of Earnings Amount:)

.(11) Loss of Income.
(Loss of Income Amount:)

Please contact cludwig@hbj-gw.com or jlawrie@hbjg-gw.com for further information.