Claim Form

If you are a coach or club representative and need to report an injury to someone else or damage to their property, please complete the incident notification form on this page.

If you need to make a claim for personal injury to yourself or your son/daughter under the Personal Accident policy, please download the personal accident claim form, complete it as requested and return it to Perkins Slade.

Please note, whilst benefits are included for physiotherapy, manipulative massage and soft tissue treatment, this is not a private health insurance and the costs of medication, private consultation and surgery are not insured benefits.

If you have any queries please call Perkins Slade on 0121 698 8140.

Click here to download our Personal Accident form or please complete the form below to report an injury to someone else/damage to someone's property.

Incident Notification

Are you, the person notifying the incident, a member, a coach, a tutor or a club representative? *
Member Coach Tutor Club representative
What is your membership number? *
What is your club affiliation number? *
Name: *
Address: *
Postcode: *
Daytime Telephone Number: *
Email Address: *
Course Title: *
Venue Address: *
Was the incident reported to the venue for logging in the accident book? *
Yes No
Please provide the name of the person who dealt with the report: *

Details of the insured

Is the insured person a member, a club or a coach? *
Member Coach Club representative
What is the insured's membership number? *
What is the insured's club affiliation number? *
Name: *
Address: *
Postcode: *
Daytime Telephone Number: *

Details of coach

Name of coach:
Coaching qualifications:

Type of notification

What type of incident are you notifying? *
Injury to a person Damage to property Both of the above

Injury - details of the injured party

Name of injured person*
Address:
Postcode:
Date of Birth:
Daytime Telephone Number:
Occupation:
Details of injuries:*
Level of experience*
Novice Intermediate Experienced

Property Damage - incident details

Place of incident*
Date of incident*
Time of incident*
Circumstances of incident:*
What property has been damaged?*
Who owns the property that has been damaged?*
What is the estimated value of the property that has been damaged?

Claim

Has a claim been intimated?
Yes No
In your view who is reponsible for the incident?
Please outline any implied or actual threat of legal action arising out of the incident?
Is there any other information you would like to provide?

Witnesses

Are there any witnesses to the incident? *
Yes No
Witness Details - Name and telephone number for each witness:

The information you have provided will be used by Perkins Slade to process your notification. As part of this process, data will be passed onto your insurer. For more information about Perkins Slade's Privacy Policy click here.

British Gymnastics is an Introducer Appointed Representative of Perkins Slade Ltd, 3 Broadway, Broad Street, Birmingham, B15 1BQ which is authorised and regulated by the Financial Services Authority. Perkins Slade FSA Register Number is 30288. You can check this on the FSA's Register by visiting the FSA's website www.fsa.gov.uk/register/ or by contacting the FSA on 0845 606 1234.
Perkins Slade Limited is registered at Companies House in England and Wales under Company Number 969374.
Registered Office: 3 Broadway, Broad Street, Birmingham, UK, B15 1BQ.