MTBA App
Complete the form then select Submit.
Rep name
*
Rep email
*
Member's name
*
Phone no. of member or next of kin
*
Nature of enquiry
*
Nature of enquiry
Road accident
Work injury
Property damage
Superannuation insurance
General insurance
Wills and estates
Medical negligence
Asbestos and dust diseases
Other
Employer/Worksite
*
Will kit shipping address
*
Shipping address 2 (Hidden)
Suburb
*
Postcode
*
State
*
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
Select...
Number of will kits
*
Other Information
*
State/Location
*
State/Location
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
Nearest office
*
Nearest office
Brisbane
Browns Plains
Bundaberg
Caboolture
Cairns
Gold Coast
Ipswich
Mackay
Rockhampton
Strathpine
Sunshine Coast
Toowoomba
Townsville
Date and time of incident
Best time to call
*
Best time to call
Morning
Afternoon
Evening
Please specify nature of enquiry
*
Have you advised the member of this referral to Maurice Blackburn and do you reasonably believe the member will not object to being contacted?
*
Yes
No