Get Injuries Board Form A Fillable

Filling out the Injuries Board Form A is an essential step for individuals seeking compensation for injuries sustained in accidents. This guide will provide you with clear instructions to ensure that you complete the form accurately and efficiently.

Follow the steps to effectively complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Begin by selecting the type of accident you experienced. Options include motor, at work, or other. Make sure to tick the appropriate box.
3. In the Claimant Details section, provide your application number, name, home address, telephone number, gender, date of birth (in dd/mm/yyyy format), occupation, and employee number if available. Fill in all fields using block capitals.
4. Identify the respondents, the individual or company you hold responsible for the injury. Fill out the respondent details for up to three parties, including each respondent's name, address, relationship to you, contact name, and phone number.
5. If this is a motor claim, enter the additional vehicle details, including registration number, make, model, and insurance company information.
6. In the Accident Details section, provide the date, time, and exact location of the accident. Include a brief description of how the accident occurred.
7. In the Injury/Claim Details section, describe the nature of your injury and the date you first sought medical attention. Provide the name and address of your medical attendant if applicable.
8. Attach a medical report from your treating doctor. Indicate whether the report sufficiently describes your injury.
9. Answer questions regarding any previous injuries or relevant medical conditions in the past five years. If applicable, provide detailed information.
10. Complete the Special Damages section by addressing claims for loss of wages and medical expenses. Indicate your total claim amounts and any expected further expenses.
11. Review the declaration statement, confirming that all provided information is accurate. Sign and date the form.
12. Once all fields are completed, save your changes, and choose to download, print, or share the completed form as needed.

Start filling out your Injuries Board Form A online today to ensure your claim is processed efficiently.