Follow the steps to complete your Acc250 form

1. Click the ‘Get Form’ button to access the form and open it in the editor. This will allow you to begin the process of filling out your application.
2. Fill in the client details section. Provide your complete information, including the date the form was completed, your full name, claim number, date of injury, residential address, date of birth, and phone number. If your postal address is different, include that as well.
3. In the travel to treatment/rehabilitation details section, enter the date of travel, where you are traveling from, the reason for your travel, and your destination. Obtain your treatment or rehabilitation provider’s stamp along with their signature.
4. Document the total kilometers traveled for each trip, along with associated fares in the designated fields for up to six trips. Make sure to ensure accuracy in these figures as they are vital for reimbursement.
5. Attach any tickets or receipts for travel by scheduled public transport or any other non-private transportation. This documentation is necessary to substantiate your claim.
6. Review and complete the declaration section. Read the declaration carefully before signing to acknowledge that the information provided is accurate and to authorize the release of information to ACC.
7. If applicable, have your representative fill out their declaration, including their name and signature. This is necessary if the client is under 16 or unable to sign due to injury.
8. Once all fields are completed, you can save your changes, download your completed form, print it, or share it as needed.

Complete your Acc250 form online today to ensure your travel cost claims are handled promptly.