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1 Client Ref. No. Please use the Notes for Guidance when completing this form. Note 1. Note 2. Note 3. Note 4. Note 5. Note 6. * Give the name of the employee driver. Note 7. Note 8. PARTICULARS OF CLAIM - ROAD TRAFFIC ACCIDENT (Claim by Driver) IN THE Between (ii) ALTERNATIVELY: (where an employee is the driver at fault) 2001 Claimant Defendant 2. On the day of 20 the Claimant was driving h 3. The said accident occurred as a result of the negligent driving of the Defendant [the said]*. (i) driving too fast in all the circumstances; failing to see the Claimant's motor vehicle in sufficient time to avoid colliding with it or at all; along when a collision occurred between the said vehicle and a driven by one* who was employed by the Defendant and who was at all material times driving in the course of h AND employment. Claim No. 1. On the day of 20 the Claimant was driving h along when a collision occurred between the said vehicle and a driven by the Defendant. Particulars of Negligence 1 [P.T.O.

2 (iii) failing to stop, slow down, swerve, or in any other way so to manage or (iv) control [his][her] said vehicle as to avoid the said collision; 4. By reason of the matters aforesaid the Claimant who was born on the day of sustained injuries and suffered distress, discomfort, inconvenience, loss and damage. The medical report of dated 5. Particulars of Injuries is annexed hereto. Particulars of Special Damages (Past and Future Expenses and Losses) 2 Note 9. Note 10. Note 11. Note 12.

3 Note 13. * Insert name of Defendant. Note Pursuant to section 11 of the Civil Evidence Act 1968 the Claimant wishes to rely on the fact that on the * [pleaded guilty][was found guilty] before the Court of the offence(s) of for which a sentence of And the Claimant(s) seek(s): (i) STATEMENT OF TRUTH [I believe][the Claimant believes] that the facts stated in these particulars of claim are true. Signed (i) damages (ii) interest pursuant to section 69 of the County Courts Act Claimant. (ii) Legal representative of Claimant. Dated this day of 20 3 day of was imposed. The Claimant will say that the said conviction(s) [is][are] relevant in this action to the issues of negligence and causation. [P.T.O.

4 Client Ref No. This page is to be used whenever paragraph(s) within the main form need to be expanded upon. Please indicate by their respective number, which paragraph(s) are being added to Form No and Title: 7 Spa Road, London SE16 3QQ CONTINUATION SHEET Personal Injury - Form 1 (Road Traffic Accident) (Claim by Driver)

5 These notes are copyright and may not be reproduced. Notes for guidance for completion of the Particulars of Claim ROAD TRAFFIC ACCIDENT (CLAIM BY DRIVER) General - It is important that these notes are read thoroughly and that the guidance given to assist in completion of the Particulars of Claim is followed carefully. Note 1 - Insert the name of the Court in which it is proposed to issue the claim. Note 2 - The claim number should be left blank since this will be provided by the Court in which the claim is issued. Note 3 - Insert the name of the Claimant. Note 4 - Insert the name of the Defendant. In the case of an accident, caused by a driver who was driving in the course of his employment, then the Defendant would usually be the name of the employer rather than the actual driver himself. The employer would be responsible for his employee's negligence. (See also Note 6 below.) Note 5 - Insert the date of the accident, the type of vehicle (car, van, etc.) being driven by the Claimant, the location where the accident happened and the vehicle being driven by the Defendant. Strictly speaking, there is no need to put registration numbers of vehicles in the Particulars of Claim. Note 6 - If the accident was caused by someone driving in the course of their employment then it would be preferable to sue the employer who would be legally responsible for their employee's negligent driving. In such a situation this paragraph would be used. The same details would be provided as in Note 5 above, but the name of the actual driver would be placed in this paragraph. If this paragraph does not apply simply cross through the paragraph manually. Note 7 - If an employer has been sued as Defendant, then insert the name of the employee at this point. It will be the same name as appears in paragraph 2. Note 8 - The Particulars of Negligence which are already on the form will apply in most if not all cases. If, unusually, they do not, they can be crossed out. Note 9 - Under (iv) space has been left for any other allegation or allegations of negligence which it is felt appropriate to make, e.g. driving through red traffic lights, or colliding with the Claimant's stationary vehicle, etc. Note 10 - Insert the date of birth of the Claimant and give very brief particulars of any injuries sustained. Give details of the medical report (i.e. the doctor preparing the report and the date on which it was prepared). If there is no claim for personal injuries, then simply put N/A. Note 11 - This paragraph is appropriate only if there is to be a claim for provisional damages pursuant to section 51 of the County Courts Act In the vast majority of cases this will not be applicable and N/A can be inserted. Note 12 - Details of special damages should be inserted, i.e. all past and, if applicable, future losses. Examples include cost of repair work to vehicle; hire charges; cost of care following injury; insurance excess; recovery and storage charges; petrol in tank; prescription charges and other medical expenses (for example physiotherapy fees); lost earnings; any other sundry expenses such as taxi fares, telephone calls, etc

6 Note 13 - This paragraph would only apply if the Defendant, or the employed driver as the case may be, has been convicted of a relevant driving offence either in the Magistrates' Court or the Crown Court. Details of the conviction would be set out here stating the date of the conviction, the Court, the offence or offences, and the penalty. This will normally apply where there has been a conviction for driving without due care and attention or dangerous driving. If there has been no criminal proceedings, and accordingly no conviction, then again this paragraph would not be applicable and the letters N/A can be inserted or the paragraph can be crossed through. Note 14 - The Statement of Truth must be signed in every case either by the Claimant or by his/her legal representative. N.B. - Please note, if there is insufficient room in any particular paragraph of the Particulars of Claim to write what is required, then simply put the words "see continuation sheet" and then complete what is required on the continuation sheet which is provided at the end of the Particulars of Claim. On the continuation sheet would first be written, for example, "particulars of special damages continued" or "paragraph 3 continued" as the case may be. Guidance on How to Issue the Claim in a County Court A Claim can be issued (started) in any County Court in England and Wales. Addresses and phone numbers can be found in the telephone book under the heading of Courts. Starting a Claim is very simple and form N1 (the Claim Form) is available from Oyez and from any County Court Office and it is straightforward to complete. The Particulars of Claim will then be attached to the Claim form. Although Form N1 is easy to complete, the County Court Office will always give help if required. The Court will require a fee to issue the Claim and the fee will depend upon the amount being claimed. In some circumstances there may be no fee to pay. Details of fees are again available at the County Court Office. After the Claim is issued, the Court will then send a copy of it to the Defendant together with a Response Pack. The Response Pack contains the forms which the Defendant can use to reply to the Claim. The Response Pack contains an admission form, a Defence form, and an acknowledgement of service. The Court sends these forms with the Claim form and Particulars of Claim to the Defendant by first class post Spa Road, London SE16 3QQ Personal Injury - (Form 1 Notes) (Road Traffic Accident) (Claim by Driver)