Accident Report Form & Insurance Information

To report an accident or injury, please complete the below and press Submit to lodge an Accident Report to SSFA directly.  Shared Services (SS) will reply to your submission with an email on the next business day.

Cover is provided for injuries caused by active participation in officially organised games, sanctioned practice or training sessions and official functions.

FNSW Participant Insurance Summary Brochure can be downloaded: https://football-nsw.gowgatessport.com.au/important-documents/

Step 1 Accident Form

Complete the below & Submit

(* Mandatory field)

Step 2

SSFA Shared Services will then email the player (or parent - where applicable) directly with detailed information on the next steps that will assist with FNSW Insurance Programme and how to make a claim.

Step 3

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

A claim will need to be lodged online. You will be issued a Claim Number and can download Documentation for completion.

For all Insurance information and claim lodgement steps follow this link for:

ONLINE CLAIM FORM: https://football-nsw.gowgatessport.com.au/

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:

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

You will need to upload all relevant documents to your online claim for processing by insurer. https://football.claimsgateway.com/login