Accidents Forms




ACCIDENT REPORT FORM

JNSHC does not admit liability by the issuance of this form,/h3>

TO AVOID DELAY AND INCONVENIENCE PLEASE ANSWER ALL QUESTIONS FULLY

This form should not be taken as an admission of liability.
It is intended to provide information to assist in the handling of your claim.
Please be aware that there is no automatic right to compensation.

DETAILS OF INSURED


DETAILS OF DRIVER


PARTICULARS OF MOTOR VEHICLE CONCERNED


PARTICULARS OF DAMAGE TO INSURED'S VEHICLE

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