Use this form to apply for a workplace personal injury insurance policy with WorkCover Queensland.
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(including but not limited to- machine/vehicle operation, tradesman etc)
* example, John Smith
example, 11635839852 (when entering the ABN do not include spaces)
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* Your insured benefit level is used to calculate your premium. This is your annual declared income level and will usually be the same as the income you would declare to the Australian Taxation Office