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Your Lodgement of a Workers' Compensation claim notification

Progress: Employer details arrow Injured worker details arrow Injury details arrow Contact details arrow Summary

Employer details

To lodge a claim, please answer the following questions. All questions marked with an * are mandatory.

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Incident only?

Yes No

Policy details

Please enter your policy number and if appropriate the cost centre and risk number

Level 1 Level 2 Level 3 Level 4 Level 5

Employer's details

Please enter your address details

Employer's mailing address

Is the above address also your mailing address? *

Yes No

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Allianz Australia Workers' Compensation (NSW) Limited AFS Licence No. 296559 Privacy | Security | Disclaimer  
ACN 003 087 545  ABN 17 003 087 545
As Agent for the NSW WorkCover Scheme ABN 83 564 379 108
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