[Specialist Assessing Services] Stephen Jones
I. Eng. A.A.E. F.I.M.I. M.I.R.T.E. M.S.O.E.
6 Chapel Court, Wervin Road
Chester CH2 4BT.
INDEPENDENT CLAIMS ASSESSORS AND CONSULTING ENGINEERS Telephone: 01244 380240

   
YOUR DETAILS  
Contact Name
Contact Numbers
Fax
Email
Company
Address
   

   
CLAIM DETAILS  
Claim Number
Cover [please select]
Date of Accident
OK to [please select]
Excess £
VAT Status [please select]
   

   
INSURED DETAILS  
Name
Address
Contact Numbers
Fax
Email address
Vehicle Registration
Vehicle Make/Model
   
Vehicle Location (if different from above) - repairers name
Address
Contact Numbers
   

   
THIRD PARTY DETAILS  
Name
Address
Contact Numbers
Fax
Email address
Vehicle Registration
Vehicle Make/Model
   
Vehicle Location (if different from above)
Address
Contact Numbers
   

   
AREAS of CONTACT



Damage Areas


 

INSURED VEHICLE - Please indicate main area of damage [please select]
Front Nearside Front Offside Front
Rear Nearside Rear Offside Rear

Extra details

THIRD PARTY VEHICLE
Front Nearside Front Offside Front
Rear Nearside Rear Offside Rear

Extra details

 


   
ADDITIONAL DETAILS  
Additional Comments
Photographs Required Yes No [please select]
   

   
IMAGES  
Attach Image or Document file
(max 5mb)
   

   
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