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.
Description of Accident _________________
_________________
_________________
_________________
_________________
Date _________________
Time _________________
Location _________________
_________________
Please ask your insurance company or solicitor to contact me as soon as possible.
Yours sincerely
Signature _________________
Name _________________
Address _________________
_________________
Health warning: A form of this nature will usually precede a court case, in which you may need the help of a solicitor. You should only use this form if the loss of property or injury to yourself is minor and you are willing to act for yourself in any court case, if it is not possible to agree a settlement with the defendant or his insurers. If you do not wish to represent yourself you should leave all correspondence, including an initial letter such as this one, to your solicitor.
Note: Enter a description of the accident. For example ‘whilst I was [driving] /[sitting as a passenger in] motor car registration number [___] that car was struck by a motor car, registration number [____] driven by [you] / [your agent]. [As a result, I suffered bodily injury.] or ‘During the course of my employment with you I fell from a platform and suffered bodily injury’.
