Get Md Msysa Claim Form 1955 2016-2025

Filling out the MD MSYSA Claim Form 1955 online is an essential process for those seeking to report injuries within the Maryland Youth Soccer community. This guide will provide you with straightforward steps to ensure that your claim is submitted accurately and efficiently.

Follow the steps to complete the MD MSYSA Claim Form 1955 online.

1. Click the ‘Get Form’ button to access and open the MD MSYSA Claim Form 1955 in the online editor.
2. Begin with Section I, which requires information about the claimant, parent, or guardian. Fill in the name, address, and contact details. Specify the date of birth and identify the claimant's role, selecting options such as player, coach, or official.
3. Record the accident date and time, noting whether it occurred during practice, a game, or an event. Indicate the body part that was injured and provide a detailed description of the incident, including the name of the field or facility.
4. Move on to Section II to provide details about the team, club, or league associated with the claimant, specifying the type and location of the activity, as well as the playing surface and its condition.
5. In Section III, complete the required policy information, ensuring that you verify the accident occurred during a sanctioned activity and that the claimant was a member at the time.
6. In Section IV, provide information about other insurance policies that may cover the claimant's injury, including relationships to the claimant and relevant employer information.
7. Complete Section V, which involves the assignment of benefits, and Section VI, which is a certification statement. Make sure to include the necessary signature of the parent, guardian, or claimant.
8. Once all sections are completed, review the form for accuracy. Users can then save changes and choose to download, print, or share the completed form for submission.

Ready to submit your claim? Complete the MD MSYSA Claim Form 1955 online today.