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FirstCall Usdaw Claim Form

Complete the below form to register your injury. Within a few working days, you will get to speak to an expert solicitor who will provide free, no obligation advice on your claim.

Alternatively, call FirstCall Usdaw to start your accident, injury or disease claim on 0800 055 6333 and speak to a solicitor immediately. Lines are open 24hrs a day, 7 days a week.

If you have a query about an existing personal injury claim, please contact your solicitor directly.

Information on how we process and store personal data can be found in our privacy notice.

* Indicates required field

Usdaw Member details
Membership Number
Title
Forename(s)*
Surname*
Postcode*
Date of birth*	DD/MM/YYYY
Contact number*
Email
_______________________
Who is the personal injury claim for?
(1) Usdaw member
(2) Family member living with the Usdaw member (non-work related accidents only)
Please complete the details of the family member you are claiming for below:
Relationship to Usdaw member
Title
Forename(s)
Surname
Postcode
Date of birth	DD/MM/YYYY
Contact Number
Email
(3) On behalf of a deceased Usdaw member
Your relationship to Usdaw member
Title
Forename(s)
Surname
Contact number
Email
_______________________
Accident Details
Type of accident*
Brief description of accident and injuries*
Date of accident*	DD/MM/YYYY
I consent for my details to be shared with the Usdaw panel solicitors and I formally instruct them to be my legal representatives under the union’s rules of assistance*	I agree
How did you hear about FirstCall Usdaw?

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