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ACCIDENT CLAIM NOTICE

Date _______________

To

Dear

You are hereby notified of a claim against you for damages

arising from the following accident or injury, to which I

believe you and/or your agents are liable.

- 1 -
Description of Accident _______________

Date _______________

Time _______________

Location _______________

Please ask your insurance company or solicitor to contact me

as soon as possible.

Yours sincerely

- 2 -
Name _______________
Address _______________
_______________ _______________
Telephone _______________

- 3 -

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