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Whose fault was the accident?
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My fault
Somebody else
50/50
Not sure
Where did the accident take place?
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England/Wales
Scotland
Northern Ireland
Is your car still roadworthy?
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Yes
No
Not sure
Photos
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First Name
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Last Name
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Email Address
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Phone Number
Car Registration
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Date of accident
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DD slash MM slash YYYY
Make
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Model
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