Request Form For Help From Injury Assistance Guarantee Fund
Personal Information
Contact Info
# Document Type Upload File
1 Accident Report of ROP
2 Legal Agency
3 Technical Report issued by ROP
4 Offender Vehicle Ownership
5 Victim Vehicle Ownership
Accident Parties
You can select multiple documents for the Treatment bills.
# Full Name Identity Number Situation Type Documents
1 * * *
Id Card*
Treatment Bills*
Medical Report*
Death Certificate*


  • Submitting the application doesn’t mean final admission. FSA may reject the application.
  • Injured person compensation fund covers only third party insurance policyholders.
  • Injured persons compensation fund covers only the traffic accidents from 15 April, 2018.

Pledge and Commitment

    I, the applicant , hereby declare all the attached statements and documents are correct, otherwise the competent entity may take all the required actions. I also subrogate the fund all the rights and to take all legal actions including instituting proceedings including granting a power of attorney to whoever it sees fit or law firms to sue the driver or owner of the vehicle that caused the accident where the vehicle or owner or driver is identified