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GAA Injury Scheme Administered by Willis, Grand Mill Quay, Barrow St, Dublin 4. Tel: [removed]Fax: [removed]Email: [removed] GAA INJURY CLAIM FORM
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Document Date: 2013-01-23 16:07:01

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File Size: 185,70 KB

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City

Dublin / /

Currency

EUR / /

/

Facility

College etc / Club Date / /

/

IndustryTerm

medical insurance / medical insurance e.g. / /

Organization

COMPLETION BY SOCIAL WELFARE OFFICE / Department of Social and Family Affairs / Social Welfare Office / Social Security Agency / /

Person

Match Claimants / Quinn Healthcare / EMPLOYED CLAIMANT / /

/

Position

THE DOCTOR/ DENTIST / Signature Official / Post Operative / Official / County Secretary / Accountant / Club Secretary / Dentist / trader / SECRETARY AND COUNTY SECRETARY / Manager / Officer / Club Chairman/Secretary / e.g. farmer / CLUB SECRETARY AND COUNTY SECRETARY / /

Region

NORTHERN IRELAND / /

Technology

MRI / /

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