APFC Injury Insurance Report Form

APFC Injury Insurance Report Form
It is essential that the Injury Report is completed at the time of the incident, or as soon as possible after it happens. This step is extremely important for any future insurance claim.

Accurate and timely information helps the club monitor player welfare and provide appropriate support where needed.

If no Injury Report has been submitted at the time of the incident, it places the Club in a position where we are unable to verify that the injury occurred, which may delay or affect the claim being approved.

If an injury requires an insurance claim, this can be lodged directly through Gow Gates via the following link: https://football.claimsgateway.com/login
Date Of Report

MonthDayYear
Date
Date of Injury

MonthDayYear
Date
Players FFA Number
Time of Injury
Players Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Team
Injured Players Address

House Number

Street

CityState / Province

Postal / Zip Code
Email
example@example.com
Mobile Number
Please enter a valid phone number.Format: (000) 000-0000.
Venue of Injury:
Opposing Club or Training:
Nature of Injury and how did it occur?
Should be Empty: