ClaimsRefund.com - Personal Injury Form

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Have you had an accident in the last 3 years?

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- Step 1 of 4

When did the incident occur? *

Less than 3 years
More than 3 years

What type of accident: *

Road traffic accident
Work related injury
Other

Name *

First

Last

Email *

Phone *

When would you prefer we call: *

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