MKB Law Claims Enquiry Form
Thank you for your enquiry to our Claims Department. Please complete the following form to provide us with information about your issue. When you submit, this form will be sent to our team to review and someone will be in contact with you to discuss. Please note that all information is strictly confidential.
1. Your Name *
Your answer
2. Contact Telephone Number *
Your answer
3. Email Address *
Your answer
4. Date of Birth *
MM
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DD
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YYYY
5. Your Home Address *
Your answer
6. Your National Insurance Number *
Your answer
7. Date of incident or accident *
MM
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DD
/
YYYY
8. Please provide a brief description of events *
Your answer
9. What damages or injuries were sustained? *
Your answer
10. If applicable, did you receive any other advice or medical treatment? *
Your answer
11. Who was the incident or accident reported to? *
Your answer
12. Did they investigate and what was the outcome? *
Your answer
13. Any other information that my be relevant? *
Your answer
14. What action do you wish to take now? *
Your answer
15. How did you hear about MKB Law? *
Your answer
Important Information
It is important that you talk to a solicitor as soon as you believe you may be entitled to claim as there are very strict time limits involved. It is imperative you fill this form in urgently and submit to us. Please note that provision of this form does not constitute an instruction of our Firm, it is simply the provision of information supporting an enquiry. Upon receipt of this form we shall respond to your enquiry as soon as possible to advise you if we can assist you. In the absence of a consultation and formal instruction on our terms and conditions we shall not be taking any steps to protect limitation or provide you with advice. Your personal data will be treated with confidence and you may request that we remove your data from our database at any time.
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