Forms

The National Injury Insurance Scheme (QLD) Notification form has been discontinued.

If you have sustained a serious personal injury in a motor vehicle accident and have a question about the National Injury Insurance Scheme, Queensland (NIISQ), please call 1300 607 566.  You can apply to NIISQ by completing the application form below:

Fillable version:  Application Form – Interim Participation and Medical Certificate
(Published 02 May 2019)

Printable version:  Application Form – Interim Participation and Medical Certificate 
(Published 02 May 2019)

If you have made a CTP claim against an insurer, the insurer may make an application on your behalf:

National Injury Insurance Scheme (QLD) Application Form – Insurer
(Published 26 November 2018)

Note: If you are injured in a work-related incident you need to complete an application form for workers’ compensation from your workers’ compensation insurer. You can access the forms and process at Worksafe. Further details are also found on the Work-related accidents page.

Other forms:

National Injury Insurance Scheme (QLD) Internal Review Application Form
(Published 23 June 2017)

Medical Assessment Tribunal Referral for Medical Matter

Preservation Notice

Consent to exchange personal information form

Vocational Rehabilitation Suitable Duties Form

Application for refund of approved transport expenses

Equipment Request Form

Continence and consumables form

Statutory Declaration:

If you have lost your receipt and wish to claim a reimbursement, a statutory declaration is required by the National Injury Insurance Agency, Queensland (NIISQ Agency). The statutory declaration forms are located on the courts.qld.gov.au website at:

Statutory Declaration (Fillable PDF form)

Statutory Declaration (Word document)