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Claim notification - Low value personal injury claims in employers' liability - accident only (£1,000 - £25,000)

Document Cited authorities 5 Cited in Related
Vincent
Published date21 March 2018
Subject MatterRoad Traffic Act personal injury forms
Claim notication form (EL1)
Low value personal injury claims in
employers’ liability - accident only (£1,000 - £25,000)
Claimant’s representative - contact details
Name
Address
Contact name
Telephone number
E-mail address
Reference number
Defendant’s details
Defendant’s name
Defendant’s address*
Policy number reference (If not known insert not known)
Insurer/Compensator name (if known)
Date sent / /
Postcode
Before lling in this form you are encouraged to seek independent legal advice.
Postcode
Items marked with (*) are optional and the claimant must make a reasonable attempt to complete those boxes.
All other boxes on the form are mandatory and must be completed before being sent.
Please tick here if you are not legally represented? If you are not legally represented please put your details in the
claimant’s representative section.
What is the value of your claim? up to £10,000 up to £25,000
EL1 Claim notication form (04.13)
This is a formal claim
against you, which must
be acknowledged by
email immediately and
passed to your insurer.

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