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Road Traffic Accident Claim

Contact

Name
Contact Details



Provide any phone numbers and an email address you are happy for us to contact you on.
About Your Accident



Please tell us how and when the accident happened.

We may require further information, which will be gathered when we call you back.
About Your Injuries
Did you visit your GP?

Did you visit the hospital?

Please tell us a little about your injury.



We also conduct a friendly medical examination, which determines the amount of compensation you will receive.
Your Vehicle Details


Are you the owner /
registered keeper?
We need your vehicle information to validate your claim against the third party.
Third Party Details




The third party information is optional, but we will require the vehicle registration to start the claim.
Vehicle Damages
Do you want Lance Mason to repair your vehicle?



Where is your vehicle stored?



Do you require a hire vehicle?



We ensure you get the maximum compensation available if your car is declared a total loss.
Additional Passengers
Number of Passengers