Bank details form for TAC clients
You can use this form to have your TAC payments deposited into your bank account by EFT.
You can also use this form to change your bank account details with us.
Certificate of Capacity form
The Certificate of Capacity form is for authorised providers to provide information about their TAC patient’s transport accident conditions and to assess and certify their capacity for work as a result of these injuries.
It is an offence under the legislation to provide false or misleading information. A person who provides a false or misleading certificate of capacity could be liable to prosecution.
Please provide feedback about the Certificate of Capacity to firstname.lastname@example.org
Changes in family circumstances
Use this form if you are on LOEC and there is a change to your family circumstances.
Any changes to the number of dependants you have can effect your LOEC benefit.
Funeral and dependency benefits claim form
This form needs for be completed and returned to the TAC to claim funeral expenses and/or dependency benefits after a person has died as a result of a transport accident. The introduction section sets out what information and official documents need to be provided regarding the deceased person's spouse, partner and dependant children.
Household support services declaration form
This form can be used to claim payment or reimbursement for household support services (required as a result of your accident injuries). Details that need to be completed include dates when services were provided, start/finish times, hourly rate and total cost.
Informal review request form
This form needs to be completed by clients (or their representative) to request an informal review of a claim decision or funding denial. It also outlines the TAC's process for acknowledging and assessing informal review requests.
This can be completed using the Online Informal Review form
Medical excess declaration form
If the medical excess applies to you, you are responsible for the first $651 of your treatment costs outside of hospital. The medical excess declaration form needs to be completed when you have reached this amount.
Pharmacy (Chemist) declaration form
Use this form to claim pharmacy purchases. This includes prescription and over-the-counter medications that you need as a result of your accident injuries. You need to attach itemised, original receipts to the completed form.
Statement of earnings
If you are on LOEC, use this form to tell us about all your income, earnings and losses each year.
Under the Transport Accident Act 1986, all TAC clients receiving LOEC benefits need to complete this form each year.
Travel expense declaration form
This form is to be used when claiming reimbursement for travel (i.e. private vehicle, public transport and/or taxi) expenses to attend: medical treatment for accident injuries; medical examinations arranged by the TAC; approved rehabilitation or disability services; or work, if you are participating in a formal Return to Work program.
Travel to work declaration form
This form is for claiming expenses related to travel (by private car, public transport and/or taxi) to work. (Claims for travel expenses to attend medical treatment and/or rehabilitation need to be made using a separate form titled Travel Expenses: Declaration).