Gallagher Bassett Unicorn Motor Collision Form

* Are you in a safe location?

* Are there any charges occurring in relation to where your vehicle is at present, i.e parking/storage?

* Do you require roadside recovery or windscreen replacement?

* Your First Name

* Your Second Name

* Your Contact Telephone Number

* Email

If you are not the driver of the vehicle please advise what your relationship is to the driver

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