Aussie Claim Fact Check

Have you ever been a member of any super fund?

Yes No

Did you leave your last job due to an injury or illness?

Tap Yes if you ceased work and have not returned since

Yes No

Have you been off work for 3+ months?

Yes No

Are you able to return to any sort of work?

Tap Yes if you will be able to work, either on full or light duties

Yes No

When did your injury or illness occur (approximately)?

less than 3 months 3-6 months 6+ Months

Did you stop work permanently before 2001?

Yes No

Which state do you live in?

Which year were you born?

What is your name?

First Name

Last Name

How should we contact you ?

Email

Phone

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Have you ever been a member of any super fund?

Did you leave your last job due to an injury or illness?

Have you been off work for 3+ months?

Are you able to return to any sort of work?

When did your injury or illness occur (approximately)?

Did you stop work permanently before 2001?

Which state do you live in?

Which year were you born?

What is your name?

How should we contact you ?

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