Bookings | Do I have a claim? – Kutlwano & Associate (Pty) Ltd

First Name

Last Name

Mobile Number

Email Address

Date of Accident

yyyy-mm-dd

Place of Accident

Claim Details

Are you claiming for injuries suffered by an individual?

Claiming for damages a person has suffered as a result of the death or injury to another?

You were a

Passenger

Driver

Pedestrian

Have your injuries resulted in a permanent or long term physical or mental impairment

Yes

What is your preferred method of contact

Landline

Cellphone

Preferred Language

Landline

Cellphone

Terms & Conditions

I accept the Terms & conditions

Terms & Conditions: Submitting this will generate an online information sheet. It does not establish an attorney and client relationship nor does it mean you have instructed us to proceed with a claim on your behalf.

Comments

Bookings | Do I have a claim?

Road Accident – Do I have a claim?