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 Scheme, please call 1300 607 566.  You can apply to the Scheme by completing the application form below:

National Injury Insurance Scheme (QLD) Application Form – Interim Participation

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

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 How to apply page.

Other forms:

National Injury Insurance Scheme (QLD) Internal Review Application Form

Medical Assessment Tribunal Referral for Medical Matter

Preservation Notice

Declaration and Authority to Exchange Information

Vocational Rehabilitation Suitable Duties Form

Statutory Declaration:

If you have lost your receipt and wish to claim a reimbursement, a statutory declaration is required by the 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)