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Injury or Damage Compensation Claim Form

About you
All fields marked with * are mandatory.
 
 
Title:*
Title of the reporter
Please Type*
 
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Your Claim
 
What type of claim would you like to make?:*
Type of the claim
 
 
 
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Today
 
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Maximum 4000 characters including spaces
 
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Was there an injury sustained from this incident?:*
Option for Injury Sustained question
 
Are you the injured person?:*
Are You Injured Person Options
If no, your relationship to the injured person:
 
 
Was anybody hurt?:*
anybody hurt question options
 
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Maximum 4000 characters including spaces
 
Did any injured person require medical assistance?:*
Options for Medical Attention Required
 
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Maximum 4000 characters including spaces
 
 
Was there property damaged?:*
Property Damage Options
 
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Maximum 4000 characters including spaces
 
 
Does this involve a motor vehicle accident?:*
Vehicle Questions
 
 
Please Advise
 
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Reporting and Insurance
 
Have you reported the issue to Council prior to completing this form?:*
Have you reported to Council
 
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Have you made a claim with your insurer for this incident?:*
Insurance Question Options
 
 
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Please provide details of the type of compensation sought. For property/vehicle damage claims, please attach any supporting documentation to substantiate your loss. Please also note that the request of this information should not be seen as an automatic acceptance of liability. All claims are assessed based on their merit.
Maximum 4000 characters including spaces
Supporting Documents
 

In accordance with the Civil Liability Act 2002, the onus is on the claimant to prove their loss. As such you will need to provide supporting evidence including photographs, building/structural reports, plumbing reports and any other relevant information.

Each file size must not exceed 2 MB. Total size of files uploaded must not exceed 10 MB. If you want to submit more files, please forward to mail@georgesriver.nsw.gov.au quoting the claim reference.

 
 
 
 
 
 
Maximum 4000 characters including spaces
 
Declaration
 
Declaration:*
 
 
 
Security code:*
 
 
Warning
 

The making of false or misleading statements may have civil or criminal penalties. The information in the form will be used to investigate the incident, only. Council admits no liability to a person completing the form.


Privacy Notice
 

Georges River Council is required under the Privacy and Personal Information Protection Act 1998 to collect, maintain and use your personal information in accordance with the Information Privacy Principles. Your personal information is being collected to process your application. Council may use your personal information for the purposes of processing your application. Council is regarded as the agency that holds the information and will not disclose your personal information without your consent unless authorised or required by law. You may apply to access or amend your information by contacting Council on 9330 6400 or at mail@georgesriver.nsw.gov.au



 


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