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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.
It is the utmost importance always to obtain the names and addresses of witnesses
I/We declare that the information given in this form is true and correct to the best of my/our knowledge/belief.
I/We further declare that the statements above can be relied upon in the contemplation of litigation proceedings which may arise.