Service Required

Personal injury and Vehicle damages

Driverà

Passengerà

Name: Abdul Hamid

Name:

Address: ** *********** **, ********.

POST code: RM8 2RA

D.O.B: 24/11/1979

N.I. Number: SG581912A

Mobile: 079********

Email: ad4oht@r.postjobfree.com

Address:

Post code:

D.O.B:

N.I. Number:

Mobile:

Number Of Total Occupants in The Car: 1

Your Place in The Car:

Marital Status: Married

Occupation: Private Hire Driver

Injury Detail: Neck, upper and lower Back, shoulders, and fear of travel

Marital Status:

Occupation:

Injury Detail:

Time Off Work: yes

Losses of earning: yes

Time Off Work:

Wages Lost:

Registration of the vehicle you were travelling inà

Insurance Detailsà

Registration No: AF12 GXZ

Make & Model: Toyota Prius

Colour: White

Insurance Company:

Policy No:

Claim Ref. No.

Third Party Detailsà

TP Vehicle Detailsà

Driver: name: Not provided

Driver: Address: Not provided

Tel: Not provided

Driver Name: Not provided

Registration No: FP60 UKJ

Make & Model: Toyota D-CAT T4

Colour: Silver

Insurance Company: TESCO Underwriting

Policy No: 4752825K

Accident Detailsà

Date & Time: 08/06/2022 AT08.36

Weather & Road Conditions: Normal, Dry

Location: Junction of Green Lane and Dunkeld Rd, Dagenham

Purpose Of Journey:

Brief Description: I was turning from Green Lane to Dunkeld Rd. When I turned on the Dunkeld Rd a pedestrian crossing the road. I stopped my vehicle. While I was stationary, TPI collided at the driver side rear.

Personal

Police Calledà

Police Station:

Officers Name:

Ref No: CAD-1557/8THJUNE2022

Tel:

Witness Detailsà

Name: N/A

Tel:

Address:

TELEPHONE

MOBILE:

Any other Detail:

Hospital Details:

GP Details:

Date Attended: Yes

Hospital Name: King George

Date Attended: Yes

Surgery Name:

Storage Address If We Are Dealing with The Vehicle Damage: à

Address: Client’s home address

Tel:

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