1. Claim Request Form Л3-53 – an original
2. Accident Information Form ЛЗ 51 - an original
3. Medical documents for rendered first aid and treatment conducted:
   - discharge summaries,
   - outpatient cards,
   - interpretation of imaging test results
   - tests, etc.
4. All of the above mentioned medical documents - a copy
5. Actually used sick leave notes: primary one, the remaining - representing uninterrupted continuations - a copy with “True to the Original” inscription, ink-stamped and signed by the Employer;
   * For persons with discontinued health insurance rights, as per the Social Security Code, a sick leave note is not to be submitted
6. An official document, containing the heirs’/beneficiary’s bank account, if it has not been indicated in Form ЛЗ 53 – a copy
7. Upon a road accident*– a document from the control authorities that have visited the accident scene
8. Upon a road accident* – a document for a taken blood sample for alcohol testing and its results, if the injured person is a vehicle driver- a copy
9. Upon individual insurance:
   - Insurance policy
10. Upon group insurance at the Employer’s expense:
    - Company Certificate from the Employer that the person is insured - an original
11. Upon group insurance at the Insurees’ expense:
    - A copy of the insurance policy and a list of Insurees’ names

    In case the sums will not be received by the eligible person:

    Notarized power of attorney from the entitled person, if the sums will be received by another person. The power of attorney must contain a statement (text) that the eligible person has been notified that he is entitled to receive the sums in person.

Upon an ACCIDENT AT WORK the following additional documents are required:

1. Declaration Statement to the National Social Security Institute about an accident at work
2. NSSI order about an acknowledged accident at work

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