Claim Application Forms

> Form A - Notice of Accident [85KB]

> Form B - Application for Scheduled Benefits [93KB]

For information on how to make a claim with MAIB click here.

Claim Benefit Forms

> Form F - Self Employed Persons Claim for Lost Wages [26KB]

> Form G - Employers Confirmation of Loss of Salary [33KB]

> Form H - Application for Direct Deposit of Payments [28KB]

> Form I - Travelling Expenses Declaration [30KB]

> Form J - Medical Certificate [30KB]

> Form N - Housekeeping Declaration [27KB]

> Form O - Living Away from Home Allowance [32KB]

> Form Q - Housekeeping Receipt [28KB]

> Form R - Self Employed Replacement Allowance Receipt [26KB]

Service Provider Forms

> Provider Application Form [20KB]