Claim Assessment

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Claim Assessment

Thank you for reaching out to us. To assess your claim and guide you through the process, please complete the form below. One of our representatives will contact you shortly.

Important: We are not the Road Accident Fund (RAF). We are a law firm that will assist you in claiming from the Road Accident Fund on your behalf.

1. Select Claim Type Please choose the type of claim you wish to file:

2. Personal Information Full Name: Email Address: Province: Phone Number: Alternative Phone Number: Preferred Contact Time:

3. Accident Details Date of Accident: Accident Role:
Driver Passenger Pedestrian Other
Was the injured person a child?
Are you claiming for someone who has passed away?

4. Injury Details Injuries Sustained (select all that apply):
Head injury
Back injury
Leg fracture
Arm fracture
Other
Is the RAF currently working on your claim?
Is another firm of attorneys currently working on your claim?

5. Accident Description & Impact Please describe the accident: What problems are you currently experiencing due to your injuries? Have your injuries affected your ability to work?

6. How Did You Hear About Us?

7. Consent By submitting this form, you consent to provide Mahlangu Attorneys with your personal information. Your data will be kept confidential and not shared for marketing purposes.

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2215 Industrial Site Chillies Block F Soshanguve 0152
012 051 0111 / 079 101 9747
mrube@mahlanguattorneys.co.za

Claim Assessment

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