---
title: "PIPA notice of claim, dependency (Form 3, version 6)"
url: "https://ailawframework.com/precedents/personal-injury-and-compensation/form-qld-pipa-notice-dependency"
type: "precedent"
site: "AI Law Framework"
id: "a21-form-qld-pipa-notice-dependency"
area_id: "A21"
kind: "form"
ai_level: "yellow"
version: 1
task_ids: ["A21-T1-R5", "A21-T1-R1", "A21-T1-R4"]
law_stated_as_at: "2026-10-23"
---

# 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.

Canonical page: https://ailawframework.com/precedents/personal-injury-and-compensation/form-qld-pipa-notice-dependency  
Law stated as at: 2026-10-23

Site index for agents: https://ailawframework.com/llms.txt

## Key facts

- Kind: Form. A form to complete, or a guide to completing an official one.
- Practice area: [Personal Injury & Compensation](https://ailawframework.com/precedents/personal-injury-and-compensation.md)
- Jurisdictions: Queensland
- AI level: Yellow. You and the tool draft together, with you directing. You check every statement you rely on.
- Law stated as at: 2026-10-23
- Status: Maintained. Checked on 2026-10-23 against the official form at publications.qld.gov.au and the 3 authorities it cites, for Queensland.

## 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

- [Draft the pre-action notice or statutory claim form from the instructions](https://ailawframework.com/practice/personal-injury-and-compensation/draft-the-pre-action-notice-or-statutory-claim-form-from-the-instruction.md)
- [Calculate limitation and pre-action notice deadlines from the injury facts](https://ailawframework.com/practice/personal-injury-and-compensation/calculate-limitation-and-pre-action-notice-deadlines-from-the-injury-fac.md)
- [Map statutory entitlements under the applicable compensation scheme](https://ailawframework.com/practice/personal-injury-and-compensation/map-statutory-entitlements-under-the-applicable-compensation-scheme.md)

## 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

## Authorities

- [Personal Injuries Proceedings Act 2002 (Qld) s 9](https://www.legislation.qld.gov.au/view/whole/html/inforce/current/act-2002-024)
- [Personal Injuries Proceedings Regulation 2025 (Qld) ss 4 and 6](https://www.legislation.qld.gov.au/view/whole/html/inforce/current/sl-2025-0110)
- [Notice of claim (dependency claims) (form 3) version 6](https://www.publications.qld.gov.au/dataset/personal-injury-forms/resource/025a031f-3511-432c-a78c-33a75f08101a)

## Official form

[Official form](https://www.publications.qld.gov.au/dataset/80a61a77-0f0e-478f-8b74-891550505708/resource/025a031f-3511-432c-a78c-33a75f08101a/download/notice-of-claim-form-3-version-6.docx)

## 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.

## Full text and drafting notes

The full text and the drafting notes are not part of this public page. Signed-in firm accounts can read them at https://ailawframework.com/precedents/personal-injury-and-compensation/form-qld-pipa-notice-dependency and through the signed-in MCP connector https://ailawframework.com/mcp/firm.

*Practice guidance for planning and review. Confirm current primary sources and the requirements of the actual matter. This is general information, not legal advice.*