Respond to an RTA personal injury claim
| Published date | 21 March 2018 |
| Subject Matter | Road Traffic Act personal injury forms |
Acknowledgment of Service
(Practice Direction 8B – Pre-Action
Protocol for low value personal injury
claims in road traffic accidents and
low value personal injury employers’
liability and public liability claims)
Name of court
Claim no.
Claimant
(including ref.)
Defendant
(including ref.)
Section A
Tick only one box
I do not intend to contest the claim
I intend to contest the amount of damages claimed but not the making of an order for damages
I intend to contest the making of an order for damages
I intend to dispute the court’s jurisdiction
(Please note, any application must be led within 14 days of the date on which you le this acknowledgment of service)
I object to the use of the procedure in Practice Direction 8B. My reasons for objecting are:
Section B
I want the claim to be determined by the court:
Tick only one box
on the papers only
(not applicable where the claimant is a child)
at a hearing
Section C
Full name of defendant ling this acknowledgment
N210B Acknow ledgment of Service (Pract ice Direction 8B – Pre-Actio n Protocol for low value personal injur y claims in
road trac accidents and low v alue personal injury employe rs’ liability and public liabilit y claims) (07.13) © Crown copyright 2013
If applicable
Fax no.
DX no.
Your ref.
E-mail
Postcode
Give an address to which notices about this case can be sent to you
Section D
*[I believe] [The defendant believes] [The defendant’s insurer believes] that the facts stated in this form are true.
*[I am duly authorised by the [defendant] [defendant’s insurer] to sign this statement]. *delete as appropriate
Signed
(To be signed by you, your insurer or by a solicitor
on behalf of you or your insurer)
Position or
oce held
(If signing on behalf of rm or company)
Dated / / Phone no.
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