Regulation 4 Information to be provided by the injured person

whether the accident, injury or disease resulted from any action taken by another person, or from any failure of another person to act, and, if so, the full name and address of that other person;

whether the injured person has claimed or may claim a compensation payment, and, if so, the full name and address of the person against whom the claim was or may be made;

the amount of any compensation payment and the date on which it was made;

the listed benefits claimed, and for each benefit the date from which it was first claimed and the amount received in the period beginning with that date and ending with the date the information is sent;

in the case of a person who has received statutory sick pay during the relevant period and prior to 6th April 1994, the name and address of any employer who made those payments to him during the relevant period and the dates the employment with that employer began and ended; and

any changes in the medical diagnosis relating to the condition arising from the accident, injury or disease.