Accident/Incident Notification Form

Please fill out the below form to start the process of reporting your accident/incident process. A member of our claims team will be in touch shorty to go through your information.

Include if differs from Risk Address
Tell us who would like to be kept informed of the claim, and how (phone/Email)
If a solicitor or Public Loss assessor has been appointed please provide details here, including contact details
Note: A copy of the form will be sent to this address.
Property/ Liability/Motor claim
Please include Eircode, if aware.
e.g. Employee of Policyholder