Accident Report Form & Insurance Information

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

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

Football NSW Insurance Information Flyer:  https://shirefootball.com.au/wp-content/uploads/2022/01/Gow-Gates_Football-NSW-Insurance-flyer-2022.pdf

 

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 be issued a Claim Number and can download Sports 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:

  • 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. https://football.claimsgateway.com/login

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.