What the form actually is
The official document is called the Personal Injury Claim Form. SIRA — the State Insurance Regulatory Authority — publishes the template. Every NSW CTP insurer accepts it. For uninsured-driver claims, the same form goes to the Nominal Defendant scheme.
Getting this form in within 28 days of the crash is what locks in backdated statutory benefits to day one. See the 28-day rule.
What's on the form, section by section
1. Your details
Name, address, date of birth, contact details, NSW driver licence number, Medicare number, bank account for payments. Standard.
2. The crash details
Date, time, location, weather, road conditions, what happened. This section is where people most often hurt their own claim. Two common traps:
- Over-explaining or guessing. Stick to what you actually saw and remember. Don't speculate about what the other driver did or didn't see.
- Accidentally accepting fault. "I should have braked earlier" or "I didn't see them coming" can get used against you later. Describe the facts, not your sense of moral responsibility for them.
We help with the wording. Honest, clean, fact-based.
3. Other vehicle and driver details
Registration, make, model, driver name and licence if you have them. Insurer if you know it. For hit and run claims, leave this blank and provide the police event number. See hit and run claim NSW.
4. Witnesses
Names and contact details of anyone who saw the crash. Independent witnesses are worth their weight in gold on disputed claims.
5. Police
Police event number. Officer name if you have it. Whether anyone was charged.
6. The injuries
What hurts, what doctors you've seen, what treatment so far, what work you've missed. Be honest about everything that hurts — not just the obvious things. Omitting an injury here can make it harder to get treatment for it later.
7. Work and earnings
Employer details. Recent payslips. Tax returns. BAS if self-employed. Days missed from work so far. The weekly income payments are calculated from this information, so it's worth getting right.
8. Declaration
Sign and date. The declaration confirms everything you've put on the form is true to the best of your knowledge. It's a serious document — get it right.
What you need to have ready
- Your NSW driver licence.
- Medicare number.
- Bank account details for benefit payments.
- Police event number or copy of the police report.
- Names and contact details of any witnesses.
- The other driver's name, address, licence, registration, and insurer if you have them.
- Names of any doctors you've seen since the crash.
- Recent payslips (last 3 months) and most recent tax return for employed.
- BAS and previous year tax return if self-employed.
Don't wait to have all of this before submitting. Get the form in inside 28 days with whatever you have, then supplement.
Where the form usually goes wrong
- Crash description that minimises the impact. Insurers read body language in the wording. Don't shrug it off.
- Injuries left off. If your back hurts as well as your neck, mention both. Adding things later is harder.
- Earnings underreported. Self-employed people often understate because of how income flows seasonally. Use a 12-month average where you can.
- Sending it to the wrong insurer. The claim goes to the at-fault driver's CTP insurer — not your own. For uninsured drivers, it goes to the Nominal Defendant.
What we do for you
One phone call. We take the details over the phone — about 20 minutes — and fill the form on your behalf. You sign, we send it in. The crash description, injury description, and earnings sections all get done the way that protects the claim. We chase any missing pieces afterwards.
Take the short check at /check, or call (02) 7238 7379 and a real person picks up.