Forms for Clients

Coronavirus update

The TAC is unable to send or receive hard copy documents at this time. We have some different options for you to send us forms, documents or receipts for reimbursement.

Please choose an option below for more information.

Reimbursements

  • myTAC
    Please use our app or web portal, myTAC to ask for reimbursements. Go to upload documents > reimbursement form and send us a photo of your receipt or proof of payment and a description of what you've paid for.
  • Email
    If you can't use myTAC to send your receipts, please take a photo and email it to us at info@tac.vic.gov.au. Include your claim number in the subject line of your email so we can process your request.

Forms and documents

  • myTAC
    Please use our app or web portal, myTAC to send forms or documents. Go to upload documents > submit documents and send us a photo of your form or document.
  • Email
    If you can't use myTAC to send your forms or documents, please take a photo and email it to us at info@tac.vic.gov.au. Include your claim number in the subject line of your email so we can process your request.

Authority to release information forms

These forms allow the TAC to obtain records or information which may affect your claim. If you do not complete a form upon request, we may not be able to assess your entitlements.

Authority to release information (general)

By law, this general authority must be completed when requested by the TAC.

Complete the Authority to release information - general form online


Authority to release information (client representative)

This form allows you to nominate another person to act on your behalf about your TAC claim, and talk about your TAC claim with TAC employees.

Complete the Authority to release information - client representative form online


Authority to release information (medical practitioner)

This form gives us permission to collect information about you from a medical practitioner. We can use the information to help us pay for the treatment and services you need. It also lets us give information to other parties so we can manage your claim.

Complete the Authority to release information - client representative form online

Authority to release information forms

Authority to release information forms

These forms allow the TAC to obtain records or information which may affect your claim. If you do not complete a form upon request, we may not be able to assess your entitlements.

Authority to release information (general)

By law, this general authority must be completed when requested by the TAC.

Complete the Authority to release information - general form online


Authority to release information (client representative)

This form allows you to nominate another person to act on your behalf about your TAC claim, and talk about your TAC claim with TAC employees.

Complete the Authority to release information - client representative form online


Authority to release information (medical practitioner)

This form gives us permission to collect information about you from a medical practitioner. We can use the information to help us pay for the treatment and services you need. It also lets us give information to other parties so we can manage your claim.

Complete the Authority to release information - client representative form online

Travel and accommodation forms

You can use these forms to claim reimbursement for different types of travel and accommodation from the TAC. Please choose the right form for the reimbursement you need.

Travel reimbursement

Use this form to claim reimbursement for travel. This could be in a private vehicle, on public transport or a taxi. The travel must be to or from:

  • medical treatment for accident injuries
  • medical examinations arranged by the TAC
  • approved rehabilitation or disability services
  • work, if you are taking part in a formal return to work program.

Resource list


Travel to work reimbursement

Use this form to claim expenses for travel to work in a private car, on public transport or by taxi.


Travel and accommodation reimbursement

The immediate family members of a hospitalised TAC client can use this form to claim travel and accommodation expenses to visit their loved one/s.

Please note, to be eligible for reimbursement, immediate family members must live more than 100km away from the hospital.

Immediate family members are the partners, parents, children, siblings and grand parents.


Travel and accommodation to go to a funeral

Immediate family members of a person who died in a transport accident can claim travel and accommodation expenses to attend their loved one's funeral.

Please note, to be eligible for reimbursement, immediate family members must reside more than 100km away from the place where the funeral, burial or cremation service was held.

Immediate family members are the partners, parents, children, siblings and grand parents.

Travel and accommodation forms

Travel and accommodation forms

You can use these forms to claim reimbursement for different types of travel and accommodation from the TAC. Please choose the right form for the reimbursement you need.

Travel reimbursement

Use this form to claim reimbursement for travel. This could be in a private vehicle, on public transport or a taxi. The travel must be to or from:

  • medical treatment for accident injuries
  • medical examinations arranged by the TAC
  • approved rehabilitation or disability services
  • work, if you are taking part in a formal return to work program.

Resource list


Travel to work reimbursement

Use this form to claim expenses for travel to work in a private car, on public transport or by taxi.


Travel and accommodation reimbursement

The immediate family members of a hospitalised TAC client can use this form to claim travel and accommodation expenses to visit their loved one/s.

Please note, to be eligible for reimbursement, immediate family members must live more than 100km away from the hospital.

Immediate family members are the partners, parents, children, siblings and grand parents.


Travel and accommodation to go to a funeral

Immediate family members of a person who died in a transport accident can claim travel and accommodation expenses to attend their loved one's funeral.

Please note, to be eligible for reimbursement, immediate family members must reside more than 100km away from the place where the funeral, burial or cremation service was held.

Immediate family members are the partners, parents, children, siblings and grand parents.

Reimbursement forms

Please choose the right form for the reimbursement you need.

Household support services reimbursement

You can use this form to claim payment or reimbursement for the household support services you need because of your accident injuries.


Pharmacy reimbursements

You can use this form to claim reimbursement for pharmacy purchases. This includes prescription and over-the-counter medications that you need because of your accident injuries. You need to attach itemised, original receipts to the completed form.

This information sheet outlines the types of Pharmacy expenses the TAC can pay for, and what information is required to pay your pharmacy accounts.

Resource list


General reimbursement form

You can use this form to claim general reimbursements that aren't covered by other TAC forms.

Resource list

Reimbursement forms

Reimbursement forms

Please choose the right form for the reimbursement you need.

Household support services reimbursement

You can use this form to claim payment or reimbursement for the household support services you need because of your accident injuries.


Pharmacy reimbursements

You can use this form to claim reimbursement for pharmacy purchases. This includes prescription and over-the-counter medications that you need because of your accident injuries. You need to attach itemised, original receipts to the completed form.

This information sheet outlines the types of Pharmacy expenses the TAC can pay for, and what information is required to pay your pharmacy accounts.

Resource list


General reimbursement form

You can use this form to claim general reimbursements that aren't covered by other TAC forms.

Resource list

You can contact a member of our Family Benefits team if you need help with any of these forms. You can contact them on 03 5225 6200 or by email at familybenefits@tac.vic.gov.au.

Funeral and dependency benefits claim form

Please use this form to claim funeral expenses and dependency benefits after a person has died in a transport accident.


Dependants statutory declaration form

Please use this form to tell us who the deceased person's dependants are.

We will also need to know details about the weekly income for both the deceased person and their spouse or partner.


Dependants acknowledgement form

Please use this form to let us know the school, university or tertiary institution enrolment of the deceased person's dependant children.

Forms for the families of people who have died

You can contact a member of our Family Benefits team if you need help with any of these forms. You can contact them on 03 5225 6200 or by email at familybenefits@tac.vic.gov.au.

Funeral and dependency benefits claim form

Please use this form to claim funeral expenses and dependency benefits after a person has died in a transport accident.


Dependants statutory declaration form

Please use this form to tell us who the deceased person's dependants are.

We will also need to know details about the weekly income for both the deceased person and their spouse or partner.


Dependants acknowledgement form

Please use this form to let us know the school, university or tertiary institution enrolment of the deceased person's dependant children.

Freedom of Information (FOI) forms

These forms can be used to make requests to the TAC to view or obtain copies of documents under Freedom of Information laws.

FOI application form

TAC clients can use this form to make an FOI request. Please note that a fee may apply.

Resource list


FOI application form (represented client)

A TAC client's representative can use this form to make an FOI request. Please note that a fee may apply.

Freedom of Information forms

Freedom of Information (FOI) forms

These forms can be used to make requests to the TAC to view or obtain copies of documents under Freedom of Information laws.

FOI application form

TAC clients can use this form to make an FOI request. Please note that a fee may apply.

Resource list


FOI application form (represented client)

A TAC client's representative can use this form to make an FOI request. Please note that a fee may apply.

Repay your sick leave to employer form

Use this form to have your sick or annual leave reimbursed for time off work because of your accident injuries.

Repay your leave to employer form

Repay your sick leave to employer form

Use this form to have your sick or annual leave reimbursed for time off work because of your accident injuries.

Loss of earnings capacity forms

TAC clients who receive Loss of earnings capacity (LOEC) benefits may need to complete these forms if their family circumstances change or at the TAC's request.

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.


Statement of earnings form

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.

Loss of earnings capacity forms

Loss of earnings capacity forms

TAC clients who receive Loss of earnings capacity (LOEC) benefits may need to complete these forms if their family circumstances change or at the TAC's request.

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.


Statement of earnings form

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.

Update bank details form

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.

myTAC users can update their details on our app or web portal.

Bank details for TAC clients form

Update bank details form

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.

myTAC users can update their details on our app or web portal.

Informal review request form

TAC clients (or their representative) can use this form to request an informal review of a claim decision or payment denial.

Complete the Informal review request form online

Resource list

Informal review request form

Informal review request form

TAC clients (or their representative) can use this form to request an informal review of a claim decision or payment denial.

Complete the Informal review request form online

Resource list

Medical excess declaration form

If your accident was before 14 February 2018 and the medical excess applies to you, you are responsible for the first $651 of your treatment costs outside of hospital.

Please complete this form when you have reached this amount.

Medical excess declaration form

Medical excess declaration form

If your accident was before 14 February 2018 and the medical excess applies to you, you are responsible for the first $651 of your treatment costs outside of hospital.

Please complete this form when you have reached this amount.