McLaren Auto Body
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0131 285 0288
Email:
info@mclarenautobody.co.uk
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Essential Information
Claimant Name
Claimant Telephone No.
Claimant Email Address
Which Services Are Required?
Please tick appropriate boxes
Vehicle Repairs
Post Repair Inspection
Personal Injury
Courtesy Vehicle Required
Is your vehicle legally roadworthy?
Please tick appropriate boxes
Yes
No
Unsure
Claimant Address
Claimant Vehicle Registration No.
Claimant Insurer
Date of Accident
Accident Circumstances
At Fault Driver's Name
At Fault Driver's Address
At Fault Driver's Telephone No.
At Fault Driver's Vehicle Registraion No.
At Fault Driver's Insurer
Supplement Information
Please provide some additional information if you have the time
Injured Passenger Details
Passenger 1 Name
Passenger 1 Telephone No.
Passenger 2 Name
Passenger 2 Telephone No.
Passenger 3 Name
Passenger 3 Telephone No.
Passenger 4 Name
Passenger 4 Telephone No.
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