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Get Appendix 8 Employer''s Liability Accident Report Form - Allianz Ie - Allianz 2006-2025
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How to fill out the Appendix 8 Employer's Liability Accident Report Form - Allianz Ie - Allianz online
The Appendix 8 Employer's Liability Accident Report Form is a crucial document for reporting workplace accidents and claims. This guide provides clear instructions on how to fill out the form thoroughly and accurately, ensuring you effectively communicate the necessary information.
Follow the steps to complete the accident report form online.
- Click ‘Get Form’ button to obtain the form and open it for completion.
- Begin by entering the claim number and the full name, business address, email, policy number, date of last premium payment, business occupation, and relevant contact numbers for the employer.
- Next, provide details about the injured person, including their name, address, date of birth, marital status, occupation, and National Insurance number. If the injured person has a relationship with the employer, specify the relationship and if they reside together.
- Indicate whether the injured person was in direct employment by answering 'Yes' or 'No,' and if applicable, provide details of the contractor if they were not.
- Address the details of the accident by entering the date, time, and address where the incident occurred. Include information on when and to whom the accident was reported, if the injured person ceased work, and any further details relevant to their engagement at the time of the accident.
- Complete the claim details section by confirming whether a compensation claim has been made, if the injured person is claiming from any other source, and if they have been previously injured or received compensation.
- Describe the details of the injuries sustained by the injured person and indicate if they were taken to a hospital, providing the hospital name if applicable.
- Fill in the earnings information of the injured person and the total weekly earnings, including any bonuses or overtime for the 13 weeks prior to the accident. Additionally, provide details of all employees present during the accident.
- Read the statements regarding data protection and ensure you consent to sharing the information by providing your signature and the date.
- Review all the information for accuracy. Once satisfied, you can save the changes, download, print, or share the form as necessary.
Complete the accident report form online now to ensure all relevant details are recorded accurately and promptly.
Unless otherwise stated in your Benefit Guide or in your Table of Benefits, all claims should be submitted no later than six months after the end of the Insurance Year. If cover is cancelled during the Insurance Year, your claims must be submitted no later than six months after the date that your cover ended.
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