Form · Personal Injury & Compensation

PIPA notice of claim, dependency (Form 3, version 6)

Link to Personal Injuries Proceedings Act Form 3, version 6, for a dependency claim. All dependency claimants are nominated in the one notice, and each part is an Oaths Act statutory declaration.

Kind: Form. A form to complete, or a guide to completing an official one.
Where it applies: Queensland
AI use: Yellow You and the tool draft together, with you directing. You check every statement you rely on.
Law stated as at: 23 October 2026
Status: Maintained. Checked on 23 October 2026 against the official form at publications.qld.gov.au and the 3 authorities it cites, for Queensland.
Version: 1
Source: Link to the official form. Licence: State of Queensland publications dataset, Creative Commons Attribution 3.0 Australia. Link only: download the current form each time; do not copy it into the file.

Where this comes from

The official form is published by publications.qld.gov.au; this page is a completion guide. Last checked on 2026-10-23.

When to use it

Use when the Queensland claim is for loss from a fatal injury and is given under the Personal Injuries Proceedings Act 2002. A claim by the injured person personally uses Form 1 or Form 2. A motor-accident death uses the MAIC fatal notice, not this form, where that Act applies.

Used for these tasks

Each task page says how far AI may help with the task and what the lawyer must review.

How AI may be used

AI may check the current official form against the file and list what is missing; it writes nothing in a declaration or certificate, and the lawyer settles every statement the client signs or gives.

AI may

Check the draft is the current file from the official page and list every blank field and missing attachment
Index the documents already on the file that the form calls for, with date and author
Turn the published giving and response steps into a checklist for this matter

AI must not

Must not write any words in a statutory declaration, claimant certificate, medical certificate or other verification
Must not sign, lodge, give or serve the form
Must not decide whether a time limit has been met or whether an excuse is reasonable

The lawyer checks

The claim is a dependency claim and Form 3 version 6 is the current notice
Every dependency claimant is named in the one notice
A copy of the death certificate accompanies part 1, as the 2025 regulation requires
Both parts are declared under the Oaths Act 1867

Method: how the Green, Yellow and Red levels are decided. This is guidance for planning, not legal advice.

Authorities

Official form

Open the official form. Always use the current version from the issuer. Licence: State of Queensland publications dataset, Creative Commons Attribution 3.0 Australia. Link only: download the current form each time; do not copy it into the file..

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