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PERSONAL ACCIDENT CLAIM Form division of Insurance Wholesale LimitedLevel 1, 3 Morton Street, Freeman's Bay, Auckland 1010 P.O. Box 99 481, Newmarket, Auckland 1149 www.tai.co.nzStatement and Declaration

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How to fill out personal accident claim form

01

Obtain a personal accident claim form from your insurance provider or employer.

02

Fill out your personal details, including name, address, contact information, and policy number.

03

Provide details of the accident, including date, time, location, and a description of what happened.

04

Include any supporting documentation, such as medical records, police reports, or witness statements.

05

Sign and date the form before submitting it to your insurance provider or employer.

Who needs personal accident claim form?

01

Anyone who has been involved in an accident and wishes to file a claim for compensation or benefits.

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What is personal accident claim form?

A personal accident claim form is a document used to report an accident or injury that occurred to an individual.

Who is required to file personal accident claim form?

Anyone who has been involved in an accident or suffered an injury may be required to file a personal accident claim form.

How to fill out personal accident claim form?

To fill out a personal accident claim form, you will need to provide details about the accident or injury, including date, time, location, description of what happened, and any witnesses.

What is the purpose of personal accident claim form?

The purpose of a personal accident claim form is to document the details of an accident or injury and to request compensation for damages or losses incurred.

What information must be reported on personal accident claim form?

Information that must be reported on a personal accident claim form includes personal details of the claimant, details of the accident or injury, medical treatment received, and any expenses incurred.

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