Registration and request to consider further information
Complete this form if you want to request that Slater and Gordon reconsider any aspect of the distribution estimate provided to you in the report that accompanies the version of this notice that will be sent to you individually, and advise you of any changes that any new or corrected data will have on your distribution estimate under the proposed Settlement Distribution Scheme. Please answer all questions.
By submitting this form you will be registering your claim so that you can receive compensation from the proposed settlement if it is approved. You do not also need to submit a ‘Form A’ document if you submit this form.
Medical information release authority
If you would like to authorise Slater and Gordon to request a copy of your medical records from IHMS for use in reviewing the assessment of your claim, you can complete the Medical information release authority form and return it to Slater and Gordon.
Please note that this section of Form C is optional, and you can still request a review of your assessment if you do not complete this medical authority.