Do I Qualify?

If you think you may have a claim, use our simple form below to submit the details you have and we will let you know.

"*" indicates required fields

Your Name*

First Last

Your Email Address*

Your Preferred Contact Number*

Job description

How Old Are you?*

Describe the Accident*

Describe Your Injuries*

Do you have scarring? *

Do You Have Scarring?*

Yes

This field is for validation purposes and should be left unchanged.

Use this form to submit your details to find out if you qualify for a claim from the Road Accident Fund.