Complete this form and send it to the insurer or contact our CTP Assist service on 1300 656 919-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your personal details in Section 1. Fill in your full name, date of birth, gender, and contact information accurately.
3. In Section 2, read the declaration carefully. Ensure you understand the implications of providing false information before signing.
4. Proceed to Section 3 to describe the accident. Include details such as the date, time, location, and a brief description of what happened.
5. In Section 4, outline any medical treatment received post-accident. Attach relevant documents like medical certificates if available.
6. If claiming for lost income, complete Section 6 with employment details and attach proof of earnings.
7. Review all sections for completeness and accuracy before submitting your claim through our platform.

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