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Accident & Insurance Information

In the unfortunate event of an accident or injury, please follow the process outlined below.

Step 1 Accident Form

SUBMIT THE BELOW FORM WITHIN 72 HOURS OF ACCIDENT

Step 2

Shared Services will email the player (or parent - where applicable) direct with detailed information on the next steps if requiring an insurance claim.

Step 3

Shared Services will advise the injured player/parent to liaise with the insurer directly. www.gowgatessport.com.au/football/nsw/

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

A Gow Gates Personal Accident Claim form will need to be downloaded and completed.

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

  • The Physician’s Statement, will need to be completed by the main doctor, surgeon or dentist.
  • If you are claiming for loss of income, you will need to have your employer complete the Employer’s Statement.
  • The club president, treasurer or secretary will need to complete and sign the Club Report and then your Association will need to sign the Association Declaration of the claim form, having verified all the details completed in the form.

Completed form will then need to be sent to Shared Services via reply email.
or taken to SSFA Shared Services at Harrie Dening Football Centre, Bates Drive, Kareela 2232 (first left after turning off Princes Hwy).

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.