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0116 442 2075
Please complete the detailed accident claim form below.  Please give as much detail as you can about what you tripped or slipped on.  If you tripped or slipped in a shop or store, please report your accident to the shop or store.  Please take photos of the defect that caused you to slip or fall. If you provide your telephone number, we will only call you to discuss this enquiry.

Personal Details

From time to time Lawson-West may wish to contact you with special offers or other information that may be of interest to you. Please indicate whether or not you are happy to receive such communication from Lawson-West.
Yes
No

Accident Details

Yes
No
Yes
No
(1) Busy Urban?
(2) Quiet Urban?
(3) Rural?
Yes
No
Yes
No
(1) Before 7pm
(2) After 7pm
Yes
No
Yes
No
(1) Within 24 hours
(2) Within 1 week
(3) Longer than 1 week
(4) Not at all

Please ensure that you have completed all the required fields (marked with *) and then click submit to send the form.