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Personal Accident Claim Form

Request a Claim Form

Please complete the following form. On submitting this form, we will email you a claim form together with your claim reference number.

Claim Form Type: Travel Personal Accident

Email Address:

Please include international dialling code if currently outside UK/ Ireland (without spaces)

Telephone number:



To view all of our claim forms you must have Adobe Acrobat Reader. This is available free of charge from the Adobe web site. A link to obtain Acrobat Reader is on the next page.

Collinson Insurance Services Limited
The IDA Business Park, Athlumney, Navan, Co. Meath, Ireland
Registered in England and Wales under number 00758979
Registered Address: Cutlers Exchange, 123 Houndsditch, London, EC3A 7BU

Collinson Insurance Services Limited, trading as Intana, is authorised by the Financial Conduct Authority in the United Kingdom and regulated by the Central Bank of Ireland for conduct of business rules.