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Eightcident Claims Management Ltd.
47 Raven Row
Whitechapel
London E1 2EG

Office Tel: 020 7247 8679
Fax: 05603 434352

Email: info@8cidentclaims.com
Web: www.8cidentclaims.com
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Claims Online

Online Injury Claims

> Make claims online
> Get 100% compensation
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You can make claims online through us and find out how much money you can get for your online injury claims.

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Title: *
Client First Name: *
Client Surname: * (please check spelling)
House No.: *
Address: *
Post Code: *
DOB: * DD MM YYYY
NI Number: *
Marital Status:
Occupation:
Mobile No. *
Telephone 2:
3rd Party Admitted Liability: * Yes No
3rd Party Prosecuted: * Yes No
Hospital Visited: * Yes No
Were You: *
GP Visited: * Yes No
Your Vehicle Reg.: *
3rd Party Vehicle Reg.: *
Accident Date: * DD MM YYYY
Accident Details: *
Name Police Officer:
Police Station:
Police Reference No.:
Accident Location:
Injury Details:
Treatment Details:
Still Suffering: Yes No
If Suffering Put Details:
3rd Party Name:
3rd Party House No.:
3rd Party Address:
3rd Party Post Code:
3rd Party Phone No.:
Why To Blame:
3rd Party Insu. Company:
3rd Party Insurance Ref.:
Additional Info:
E-mail:
 
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Eightcident Claims Management Ltd.
47 Raven Row, Whitechapel, London E1 2EG
Office Tel: 020 7247 8679, Fax: 05603 434352
Email: info@8cidentclaims.com
Web: www.8cidentclaims.com
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