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PERSONAL ACCIDENT - CLAIM FORM

To submit a claim for personal injury, please download the claim form by clicking on the document below and complete as fully as possible as per the instructions provided.

Please download and complete this document if your injury was sustained between 1st September 2008 4pm Local Standard Time and 1st September 2009, 4pm Local Standard Time.

Personal Accident Claim Form *

Please download and complete this document if your injury was sustained between 1st September 2009 4pm Local Standard Time and 1st September 2010, 4pm Local Standard Time.

Personal Accident Claim Form *

Important Notice
If there appears to be a potential capital benefits claim for death or permanent disablement, please notify Horsell International immediately. Our service team will advise you on the steps you need to follow. They can be contacted by calling (02) 9247 1700, toll free 1300 722 990 or via email sports@horsell.com.

* These documents are Adobe Portable Document Format (PDF) files. You will need Adobe Reader to view them. You can download Adobe Reader for free from www.adobe.com