This form is to be completed by the Employer (where possible the Employee’s direct manager) and relates to a claim for:
•Total and Permanent Disablement (TPD)•Income Protection (IP)•Both TPD and IP
It will take approximately 20-30 minutes to complete and you may be required to upload scanned copies of:
•Job description•Rehabilitation reports and incident reports•Sick leave payslips•Proof of earnings (payslips) for the 12 months prior to the employee's last physical day at work•Leave reports (annual leave, sick leave)•Termination documents•Any other information that will assist in the assessment of the claim
You can save the form at any time, should you not have these documents readily available.
Please ensure you complete this form in full, as assessment of this claim may be delayed if the information provided is incomplete.