Create Claim Manually

Fallback route for claims that do not arrive through the client Google Form — for example a telephone referral.

Client Details

Information supplied by the claimant

Full name

Date of birth

Address line 1

Address line 2

Town / city

County

Postcode

Occupation

National Insurance number

Format QQ 12 34 56 C

Contact number

UK mobile or landline, 11 digits

Email address