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Accident Report Form & Insurance Information

In the unfortunate event of an accident or injury, please follow the process outlined below to submit Accident Report to SSFA directly.

Step 1 Accident Form

SUBMIT THE BELOW ACCIDENT FORM WITHIN 72 HOURS OF ACCIDENT TO SSFA Shared Services.

Step 2

SSFA Shared Services will then email the player (or parent - where applicable) direct with detailed information on the next steps if requiring an insurance claim. (Insurer - Gow Gates Insurance Brokers)

Step 3

The injured player/parent are to liaise directly with the insurer via online lodgement. 

A Gow Gates Personal Accident Claim will need to be lodged online. You will then be emailed your Sports Documentation & Claim Number from the insurer. 

For all Insurance information and claim lodgement steps follow this link: www.gowgatessport.com.au/football/nsw/

The insured person is to fully complete all sections of the claim documentation. In addition, the following people will need to complete their relevant sections:

  • The Physician’s Report -  will need to be completed by the main doctor, surgeon or dentist.
  • The Employer's Statement - will need to be completed by your employer, if you are claiming for loss of income.
  • The Club Declaration - will need to be completed by your club President, Treasurer or Secretary, having verified all the details completed on the form. Contact SSFA Shared Services if you require assistance with your Club Declaration.

You will need to upload all relevant documents to your GowGates online claim for processing by insurer. 

Remaining  

This SSFA Accident form should be submitted within 72 hours from the time of the accident I confirm that all information is true at the time of completion.