Personal Liability Claim – TopMark Claims Management

Personal Accident Claim

Fields marked with an * are required

Your Details

Your Details (Person completing form)

Name

Your Position

Phone

Does your claim involve one of the following? *

School Details

To confirm the correct school details, please click the following link:

Get Information about Schools - GOV.UK (get-information-schools.service.gov.uk)

Name of School

Address Line 1

Address Line 2

City

Postcode

URN

Injured Party Details

Employee's Name

Address Line 1

Address Line 2

City

Postcode

Phone

Occupation

Date of Birth

National Insurance Number

Incident & Injury Details

Date of Incident

Incident Location

Please detail the nature and extent of the injuries involved, and provide a description of the incident/how they were sustained.

What benefits are being claimed?

Please provide any other information relevant to this incident

Supporting Information

In addition to any correspondence that may have been received, please upload any internal documentation generated as a result of this incident e.g. RIDDOR report, accident book entry, internal investigation/incident report, witness statements, etc.

Please upload any documents you feel to be relevant in support of the claim.

Please note no more than 10 documents can be attached with your application but that each document cannot be larger than 50MB. Please also note that the maximum combined size of files submitted with your application cannot exceed 50MB. If you exceed this capacity your claim will not be received.

File Upload

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Risk Protection Arrangement