ACCIDENT
CLAIM NOTICE
Date:
________________
To:
__________________
You
are hereby notified of a claim filed against you for damages arising from the
following accident or injury for which, in my opinion, you and / or your agents
are liable.
Description of Accident:
_______________________________________________
____________________________________________________________________
____________________________________________________________________
Date: _________________
Time:
_________________
Location:____________________________________________________________
Please
have your insurance representative or attorney contact me as soon as possible.
Name:
_______________________________________________________________
Address:
_____________________________________________________________
Telephone:
_________________________________________
