ACCIDENT CLAIM NOTICE
Date: ________________
To: __________________
You are hereby notified of a claim filed against you for damages arising from the following accident or injury for which, in my opinion, you and / or your agents are liable.
Description of Accident: _______________________________________________ ____________________________________________________________________ ____________________________________________________________________
Date: _________________
Time: _________________
Location:____________________________________________________________
Please have your insurance representative or attorney contact me as soon as possible.
Name: _______________________________________________________________ Address: _____________________________________________________________ Telephone: _________________________________________