Make a personal compensation claim against United Welsh

If you would like to make a personal compensation claim against United Welsh, please fill in this form. Please note that this form is only to be completed if you haven’t engaged with a solicitor.

Personal details

Full name of claimant *

Address of claimant *

Email address *

Contact number *

Are you making a claim on behalf of another person? *

Yes No

If 'yes', please provide their name, address, email and contact number below

What are you claiming for? *

Loss or damage to personal property Loss of amenity Other

Alleged injury or loss suffered

Please provide a brief outline of the incident, including what, where and how it happened. If you can, please include the precise location and time and if there were any witnesses. Please provide submit any photographs to support your claim via email to tellmemore@unitedwelsh.com, providing your name as the reference. *

Why do you believe United Welsh is at fault? *

Did you receive medical attention?

Yes No

If you answered 'yes', please provide more details.

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Make a personal compensation claim against United Welsh

Personal details

Alleged injury or loss suffered

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