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WITNESS STATEMENT

If you witnessed an incident involving one of our policyholders, let us know

*Denotes compulsory field

About the claim

About the claim

Please tell us the name of our customer and the reference number
About the incident

About the incident

Please tell us about the incident you witnessed
About the vehicle that caused the accident

About the vehicle that caused the accident

Please give us details of the vehicle driven by the person who caused the incident
Were the police involved?

Were the police involved?

Please upload supporting evidence

Please upload supporting evidence

Please make sure the combined file size of all your attachments is below 20MB and no single file exceeds 5MB
About you

About you

Please tell us your name and confirm the information you've given is correct
Your title
First line of address
Second line of address
Declaration

Declaration