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1 of 2COMPLETE THIS FORM IFAn ambulance has been used within Australia. Incolink guidelines will be followed when assessing this claim. FORWARD THIS CLAIM FORM TOTotal Claims Solutions Level 1, 151 Rathdowne Street Carlton VIC 3053FOR CLAIM ENQUIRIES CALLTotal Claims Solutions (03) 9320 8588INSTRUCTIONSClaim FormThe WORKER must complete ALL questions on pages 1 and 2 of the form once the Ambulance invoice has been received. Incomplete answers and vague information will delay the assessment of the claim.This claim must be supported by proof of identity. Acceptable Documents1. A current Australian drivers license, or2. A current Australian passportIMPORTANTThe ORIGINAL fully completed claim form must be sent with ALL DOCUMENTS outlined in the checklist.CHECKLISTProof of dependant(s)Original ambulance invoiceProof of identityThe issue of this form DOES NOT constitute admission of liability on our behalf.OFFICE USE ONLYClaim numberReferenceEMERGENCY TRANSPORT CLAIM FORMEmergency Ambulance ...