Notice of Accident Claim Form

Before we can bring a personal injury claim on your behalf, we require you to complete our Notice of Accident Claim Form below.

Upon receipt of your completed Notice of Accident Claim Form one of our team will contact you to discuss your potential claim for personal injuries. Please note that all questions with an * should be completed.

CTP Medical Certificate

Before we can finalise your Notice of Accident Claim Form, you will need to have your general practitioner (doctor) complete a CTP Medical Certificate. The CTP Medical Certificate is available in the Accident Forms download area of our website. Before you see your general practitioner please make a list of all of the areas of your body that are painful and sore as a result of the accident and make sure that your general practitioner specifically refers to each of the painful areas of your body on the CTP medical certificate. The insurer will only pay for the treatment on the areas of your body that are specifically referred to on the CTP Medical Certificate. Please also ensure that your general practitioner includes a referral on the CTP Medical Certificate for physiotherapy, psychological counselling, orthopaedic specialist or any other medical specialist as appropriate.