Application for Accident Benefits

About this form

The form required to apply for accident benefits after a motor vehicle accident. Includes accident details, injured person information, and medical conditions.

The form required to apply for accident benefits after a motor vehicle accident. Includes accident details, injured person information, and medical conditions.

Who needs this form

Anyone who needs to apply for accident benefits after a motor vehicle accident in Ontario

What's in this form

• Accident information (date, location, description)
• Injured person information
• Vehicle and insurance information
• Employment and income information
• Medical condition description
• Declaration and authorization

Published by

Financial Services Regulatory Authority of Ontario (FSRA)