Client intake
Accident information

Before we begin

This questionnaire records your personal particulars and the details of the accident so that your attorney can assess and administer your claim. You may complete the sections in any order and return to finish later.

Please have ready
01Your identity document or passport
02The accident reference and police case number
03Hospital, doctor and treatment details
04Photographs of the damage, if you have them
Indemnity & POPIA consent

The information you provide is supplied directly to Savage Jooste & Adams for the purpose of assessing and administering your claim.

Your answers stay on this device until you press send. They are not stored on this website, and nothing you type is saved anywhere until the completed form is sent.

To deliver the form, the completed PDF passes through the firm's website host and its email provider. Both act only on the firm's instruction and neither keeps a copy of your answers.

Your information will not be sold, published or shared with any third party except where it is necessary for your claim or where the law requires it. It will be handled confidentially, kept only for as long as it is needed, and used solely for the purpose described above.

By continuing you confirm that the information you provide is given freely and voluntarily, and that it is true and correct to the best of your knowledge.