Union rep name *

Union rep email *

Member's name *

Phone no. of member or next of kin *

Nature of enquiry *

Nature of enquiry Injured at work Injured in a road accident Exposed to asbestos Need to make a super claim Injured by medical treatment Injured in a public place Wills – request a free will kit Will dispute Other

Will kit shipping address *

Shipping address 2 (Hidden)

Suburb *

Postcode *

State *

Select... ACT NSW NT QLD SA TAS VIC WA

Number of will kits *

Other Information *

Limited to 200 characters

Nearest office *

Nearest office Brisbane Browns Plains Cairns Caboolture 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