Deliveroo UK - Serious Injury Scheme claim form

To ensure that our claims team can efficiently handle your claim, please ensure all relevant questions relating to your claim are completed. To assist in the handling of your claim:

• Please ensure all supporting documentation is provided.
• Please ensure that all relevant questions are answered and that all appropriate sections, boxes and signatures are completed, failure to do so may delay the processing of your claim.

If you have any questions or queries, please contact Serious Law by phoning 01204 454 303 or by emailing contact@seriousinjuryscheme.co.uk. 

What you will need to complete this form:

1. Details of the incident (including location, dates and times).
2. Details of your injuries
3. Details of the responsible party (if you know them)

Preparing this information will make it easier for you to complete the form, although you can also save this form at any time and return to it later.

Section A - Claim details

Please complete this section to provide your personal details, and information about your claim.

Where did the incident take place?

Don't know where you are or exactly where the incident happened?

If you're at the incident location now, click this link and drop the 3 words into the street address line in the next step, or use the online map to search.

If you already know the incident address, you can enter this by clicking NEXT.

Section B – General Data Protection Regulation (GDPR)

We treat your personal data confidentially and with maximum security and only disclose it to third parties if there is a legal basis for doing so. We have also concluded order processing contracts and, if necessary, standard contractual clauses with all third parties who process data on our behalf. Before using a new third party, we check it for data protection reliability.

For the purposes of executing contractual relationships and fulfilling legal obligations, we share personal information with third parties assisting in the administration of your insurance policy or claim, such as claims adjusters, claims processors, accountants, auditors, banks, lawyers and other experts, including medical experts.

If you would like to learn more about how Bikmo and protects and processes personal information please visit: bikmo.com/uk/privacy-policy.

Data will be shared with Serious Law LLP for the purpose of processing the Legal Expenses claim - and they will use the data in accordance with the personal data provisions set out in their policy wording located here.

By filling out this claim form you give your consent to Bikmo processing and sharing your personal information in relation to this claim

Section C – Declaration

Before submitting your claim, please check the details and add your signature on the next section. You will then get the chance to add any more supporting information, before submitting your claim.