Victims Support Scheme - Application for Support

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If you have been injured due to a violent crime or modern slavery in NSW, you may get help through the Victims Support Scheme. The Victims Support Scheme is administered by the Commissioner of Victims Rights. The Commissioner may delegate functions to their staff at Victims Services, part of the Department of Communities and Justice.


The type of support you get, the information you need to provide and the time limits to apply will depend on your situation. Before you complete the application, please read the Victims Services website to learn about the time limits that apply to you and the information and documents you need to provide to us with your application.


This form will ask you for information about what happened, and where and when the incident(s) happened. We know violence and modern slavery can affect people in lots of different ways and understand it may be difficult to fill in this application. If you have questions or are unsure if you can apply, please contact us by phone or email.

  • Phone: Victims Access Line on 1800 633 063 or the Aboriginal Contact Line on 1800 019 123 (Mon - Fri, 9am - 5pm)
  • Email: vs@dcj.nsw.gov.au

If you have a hearing or speech impairment, call the National Relay Service on 13 36 77 (TTY) or 1300 555 727 (Speak and Listen).


If you need an interpreter, call the Translating and Interpreting Service on 13 14 50.


What will you need to complete your application form?


It is important you carefully fill in this form and include all the required information and documents. Unfortunately, if something is missing, we will not be able to accept your application.


All applications must have the following information to be accepted: 

  • Your email address 
  • A clear copy of the applicant’s current government-issued identification. If the applicant is under 18, a clear copy of a parent, step-parent or guardian’s government-issued identification is also required. These must be uploaded to the application. Accepted government-issued identification include a driver licence, passport, Medicare card or Centrelink card. To find out the full list of identification types we accept, visit the Supporting documents page on the Victims Services website. 
  • If the applicant is under 18, a parent, step-parent or guardian must complete the application on their behalf as their authorised person. If you are under 18 and applying without a parent, step-parent or guardian, please contact us before using this form.
Additional documentation may be required, depending on the support type. Visit the Victims Services website to find out what you need to provide with your application.
 

How long will it take to complete the application form? 

20 – 30 minutes.


If you are not ready to submit your application form, you can save a draft and complete it later. Just click the 'Save my progress and resume later' button at the top or bottom of the form. Saved applications will be available for 30 days from the date you started the application. If you do not submit your saved application form to Victims Services within 30 days, it will be deleted, and you will need to start the application again.


The type of support you can apply for and the time limits to apply will depend on your situation. To ensure you submit your application in time, check the time limits that apply in the Victims Support Scheme Quick Guide on the Victims Services website.


Starting your application


Complete the questions below to learn about the support that you may be eligible for based on where and when the incident(s) occurred, the nature of the incident(s), and your age at the time of the incident(s).



If the act of violence or act of modern slavery did not occur in NSW, you are not eligible for support under the NSW Victims Support Scheme.


If you have been the victim of crime outside of NSW, click the following link for details to contact the relevant victims support organisation in that state.


Please call our free Victims Access Line on 1800 633 063 or the Aboriginal Contact Line on 1800 019 123 if you would like to discuss your eligibility.



Please provide the child's details below.




DD/MM/YYYY


To ensure accurate information is given about the types of support available to the applicant, please answer the following questions with details about the violent crime or modern slavery which impacted your child and their age at the time of the incident(s).



If you were under 18 at any time during the incident(s), select 'Yes' to the question below. 



If you were a witness to the violent crime, you would generally be considered a secondary victim. A secondary victim of an act of violence is a person who is injured as a direct result of witnessing the act of violence that resulted in the injury to, or death of, the primary victim.


Parents or guardians of primary victims under the age of 18 may also be secondary victims if they’re injured as a direct result of subsequently becoming aware of the act of violence, as long as they didn't commit the act of violence.


Please call our free Victims Access Line on 1800 633 063 or the Aboriginal Contact Line on 1800 019 123 if you would like to discuss your eligibility.


If you were home when the damage occurred, you might be eligible for victims support under the categories of assault, stalking/harassment, domestic/family violence or home invasion. If you were not home, you may not be eligible to get support through the Victim Support Scheme.


Please call our free Victims Access Line on 1800 633 063 or the Aboriginal Contact Line on 1800 019 123 if you would like to discuss your eligibility.


You are ineligible for support if the crime you witnessed was modern slavery.


Please call our free Victims Access Line on 1800 633 063 or the Aboriginal Contact Line on 1800 019 123 if you would like to discuss your eligibility.


You may not be eligible for support through the Victims Support Scheme, unless the dog was told to attack you by another person. If this happened, change the nature of the incident(s) to Assault.


Please call our free Victims Access Line on 1800 633 063 or the Aboriginal Contact Line on 1800 019 123 if you would like to discuss your eligibility. 


You may not be eligible to get support through the Victims Support Scheme if you were injured by a motor vehicle accident. Information and support for people injured in motor accidents in NSW is available through the State Insurance Regulatory Authority (SIRA) website. Call SIRA's CTP Assist on 1300 656 919 to learn more.


If you are a family member of someone who has died as a result of a road crime in NSW (a road crime victim), you can apply for counselling through the Victims Support Scheme. Please call our free Victims Access Line on 1800 633 063 or the Aboriginal Contact Line on 1800 019 123 if you would like to discuss your eligibility.


You may not be eligible for support if you were not present when the incident of property damage occured. If you were present during the propert damage, change the nature of the incident(s) to  Assault, Harassment/Staling or Domestic and/or Family Violence (whichever is most relevant).


Please call our free Victims Access Line on 1800 633 063 or the Aboriginal Contact Line on 1800 019 123 if you would like to discuss your eligibility. 


Victims Support is only available to victims of modern slavery, if it occurred after 1st January 2022.


Please cal our free Victims Access Line on 1800 633 063 or the Aboriginal Contact Line on 1800 019 123 if you would like to discuss your eligibility.


For a parent, step-parent or guardian is only eligible for support if the child was under the age of 18 at the time of the violent crime or modern slavery occured.


Please call our free Victims Access Line on 1800 633 063 or the Aboriginal Contact Line on 1800 019 123 if you would like to discuss your eligibility. 


If you were 18 or over at the time of incident(s), please select 'Adult Sexual Assault'.


If you were under 18 at any time during the incident(s), please select 'Child Sexual Assault'.


A parent, step-parent or guardian who is caring for a child who has been injured as a direct result of an act of violence or modern slavery may apply for financial assistance to help with the care the child needs as a result of the violence.

Based on the information you have provided, you may be eligible for the following support. Select the support that you may want to apply for. This will determine which pages of the Application for Support you will see and need to complete.

For financial assistance for immediate needs, you will also need to provide:
  • The applicant’s bank account details, or their parent, step-parent or guardian’s (if the applicant is under 18). If you would like victims support payments to be made to an account in another name, please contact Victims Services to discuss your options, and 
  • Copies of itemised tax invoices, receipts, or treatment plans and a description of how the costs are related to the crime, or
  • A completed Claim for Immediate Needs Support Package with the required supporting documents (if claiming the Immediate Needs Support Package), and
  • The police event number, or a report that explains what happened from a government or government-funded organisation that you disclosed the incident(s) to, or
  • A medical, dental or counselling report(s) that shows how the crime affected the victim. 
For financial assistance for economic loss, you will also need to provide the supporting documents listed above, and:
  • The police event number, or a report that explains what happened from a government or government-funded organisation that you disclosed the incident(s) to, and
  • A medical, dental or counselling report(s) that shows how the crime affected the victim, and 
  • A completed Claim for Loss of Earnings with the required supporting documents (if claiming actual loss of earnings).
For a recognition payment, you will also need to provide:
  • The applicant’s bank account details, or a parent, step-parent or guardian’s (if the applicant is under 18). If you would like victims support payments to be made to an account in another name, please contact Victims Services to discuss your options, and
  • The Police event number, or a report that explains what happened from a government or government-funded organisation that you disclosed the incident(s) to, and
  • A medical, dental or counselling report(s) that shows how the crime affected the victim. If you don’t have a copy of the report(s), you can send them to Victims Services within 12 months of submitting your application. If you don’t send them to us within 12 months, your application for a recognition payment will be closed.
For a recognition payment, you will also need to provide:
  • The applicant’s bank account details, or a parent, step-parent or guardian’s (if the applicant is under 18). If you would like victims support payments to be made to an account in another name, please contact Victims Services to discuss your options, and
  • The Police event number, or a report that explains what happened from a government or government-funded organisation that you disclosed the incident(s) to, and
  • A medical, dental or counselling report(s) that shows how the crime affected the victim. If you don’t have a copy of the report(s), you can send them to Victims Services within 12 months of submitting your application. If you don’t send them to us within 12 months, your application for a recognition payment will be closed.

For financial assistance for immediate needs, you will also need to provide:
  • The applicant’s bank account details, or their parent, step-parent or guardian’s (if the applicant is under 18). If you would like victims support payments to be made to an account in another name, please contact Victims Services to discuss your options, and
  • Copies of itemised tax invoices, receipts, or treatment plans and a description of how the costs are related to the crime, or
  • A completed Claim for Immediate Needs Support Package with the required supporting documents (if claiming the Immediate Needs Support Package), and
  • The police event number, or a report that explains what happened from a government or government-funded organisation that you disclosed the incident(s) to, or
  • A medical, dental or counselling report(s) that shows how the crime affected the victim.
For financial assistance for economic loss, you will also need to provide the supporting documents listed above, and:
  • The police event number, or a report that explains what happened from a government or government-funded organisation that you disclosed the incident(s) to, and
  • A medical, dental or counselling report(s) that shows how the crime affected the victim, and 
  • A completed Claim for Loss of Earnings with the required supporting documents (if claiming actual loss of earnings).
For a recognition payment, you will also need to provide:
  • The applicant’s bank account details, or a parent, step-parent or guardian’s (if the applicant is under 18). If you would like victims support payments to be made to an account in another name, please contact Victims Services to discuss your options, and
  • The Police event number, or a report that explains what happened from a government or government-funded organisation that you disclosed the incident(s) to, and
  • A medical, dental or counselling report(s) that shows how the crime affected the victim. If you don’t have a copy of the report(s), you can send them to Victims Services within 12 months of submitting your application. If you don’t send them to us within 12 months, your application for a recognition payment will be closed.

For financial assistance for economic loss, you will need to provide:
  • The applicant’s bank account details, or their parent, step-parent or guardian’s (if the applicant is under 18). If you would like victims support payments to be made to an account in another name, please contact Victims Services to discuss your options, and
  • Copies of itemised tax invoices, receipts, or treatment plans and a description of how the costs are related to the crime, and
  • The police event number, or a report that explains what happened from a government or government-funded organisation that you disclosed the incident(s) to, and
  • A medical, dental or counselling report(s) that shows how the crime affected the victim.
For a recognition payment, you will also need to provide:
  • The applicant’s bank account details, or a parent, step-parent or guardian’s (if the applicant is under 18). If you would like victims support payments to be made to an account in another name, please contact Victims Services to discuss your options, and
  • The Police event number, or a report that explains what happened from a government or government-funded organisation that you disclosed the incident(s) to, and
  • A medical, dental or counselling report(s) that shows how the crime affected the victim. If you don’t have a copy of the report(s), you can send them to Victims Services within 12 months of submitting your application. If you don’t send them to us within 12 months, your application for a recognition payment will be closed.
For a recognition payment, you will also need to provide:
  • The applicant’s bank account details, or a parent, step-parent or guardian’s (if the applicant is under 18). If you would like victims support payments to be made to an account in another name, please contact Victims Services to discuss your options, and
  • The Police event number, or a report that explains what happened from a government or government-funded organisation that you disclosed the incident(s) to, and
  • A medical, dental or counselling report(s) that shows how the crime affected the victim. If you don’t have a copy of the report(s), you can send them to Victims Services within 12 months of submitting your application. If you don’t send them to us within 12 months, your application for a recognition payment will be closed.

For financial assistance for economic loss, you will need to provide:
  • The applicant’s bank account details, or their parent, step-parent or guardian’s (if the applicant is under 18). If you would like victims support payments to be made to an account in another name, please contact Victims Services to discuss your options, and
  • Copies of itemised tax invoices, receipts, or treatment plans and a description of how the costs are related to the crime, and
  • The police event number, or a report that explains what happened from a government or government-funded organisation that you disclosed the incident(s) to, and
  • A medical, dental or counselling report(s) that shows how the crime affected the victim.

It is important you carefully fill in this form and include all the required information and attachments listed above. If something is missing, we cannot accept your application.


You must select at least one support type from the 'Assistance available' before continuing to the next page.
Hidden System Section




You have not selected a support type!


Use the 'Previous Page' button to return to the first page to select the support type(s) you want to apply for. This will determine which pages of the Application for Support you will see and need to complete.












DD/MM/YYYY

This question is optional and is for statistical and planning purposes only

This question is optional and is for statistical and planning purposes only



NSW addresses only

















NSW addresses only
















Please re-enter the email.

Please enter a phone number without spaces or symbols (e.g. 0412312312 or 0280018001)

Please enter a phone number without spaces or symbols (e.g. 0412312312 or 0280018001)



A clear copy of the applicant’s current government-issued identification must be uploaded to this application. Please ensure the image clearly shows all details of the identification. If any part of the image is unclear, the application cannot be accepted.




Total size of all files uploaded to this form cannot exceed 30MB.




Total size of all files uploaded to this form cannot exceed 30MB.

If the applicant is under the age of 18 at the time of making the application, a responsible person must make the application on behalf of the applicant. A responsible person includes a parent, step-parent, guardian or representative of the NSW Minister for Families and Communities. If these details cannot be provided, please contact Victims Access Line on 1800 633 063 or the Aboriginal Contact Line on 1800 019 123.

A person or organisation can also be authorised to represent the applicant. An authorised person or representative can be a legal representative, someone from a support service or a family member or friend.

If your authorised person or representative is a family member or friend, you will also need to provide their date of birth and upload a copy of their government-issued identification to this application.





Who do you want to authorise to represent you?


Please provide details of the parent, step-parent, guardian, or person with parental responsibility for the child who is completing this form on the child victim’s behalf.






DD/MM/YYYY

This question is optional and is for statistical and planning purposes only

This question is optional and is for statistical and planning purposes only


A clear copy of the authorised person or representative’s current government-issued identification must be uploaded to this application. Please ensure the image clearly shows all details of the identification. If any part of the image is unclear, the application cannot be accepted.




Total size of all files uploaded to this form cannot exceed 30MB.




Total size of all files uploaded to this form cannot exceed 30MB.






NSW addresses only
















Please re-enter the email.

Please enter a phone number without spaces or symbols (e.g. 0412312312 or 0280018001)

Please enter a phone number without spaces or symbols (e.g. 0412312312 or 0280018001)




As you are the authorised person for this applicant, correspondence will be sent to you and authority is provided for all Victims Support Scheme applications.



Please provide details of the person that you would like to represent you for this application.






DD/MM/YYYY


A clear copy of the authorised person or representative’s current government-issued identification must be uploaded to this application. Please ensure the image clearly shows all details of the identification. If any part of the image is unclear, the application cannot be accepted.




Total size of all files uploaded to this form cannot exceed 30MB.




Total size of all files uploaded to this form cannot exceed 30MB.






NSW addresses only
















Please re-enter the email.

Please enter a phone number without spaces or symbols (e.g. 0412312312 or 0280018001)

Please enter a phone number without spaces or symbols (e.g. 0412312312 or 0280018001)





Please provide details of the authorised representative










NSW addresses only
















Please re-enter the email.

Please enter a phone number without spaces or symbols (e.g. 0412312312 or 0280018001)

Please enter a phone number without spaces or symbols (e.g. 0412312312 or 0280018001)



As you are the authorised representative for this applicant, correspondence will be sent to you and authority is provided for all Victims Support Scheme applications.


Please provide details of the person that you would like to represent you for this application.






DD/MM/YYYY



A clear copy of the authorised person or representative’s current government-issued identification must be uploaded to this application. Please ensure the image clearly shows all details of the identification. If any part of the image is unclear, the application cannot be accepted.


Total size of all files uploaded to this form cannot exceed 30MB.




You must provide a copy of their government issued-identification with this form and tell us their date of birth.


Total size of all files uploaded to this form cannot exceed 30MB.






NSW addresses only
















Please re-enter the email.

Please enter a phone number without spaces or symbols (e.g. 0412312312 or 0280018001)

Please enter a phone number without spaces or symbols (e.g. 0412312312 or 0280018001)


This question is optional and is for statistical and planning purposes only


This question is optional and is for statistical and planning purposes only


Hidden System Fields


If you are applying for financial assistance and/or a recognition payment, you must provide details of a bank account in the applicant’s name or the parent, step-parent or guardian’s name if the applicant is under 18 years of age. If you would like victims support payments to be made to an account in another name, please contact Victims Services to discuss your options.

If a recognition payment is approved while the applicant is younger than 18 years, the payment will be made to NSW Trustee and Guardian to hold the payment until the applicant turns 18 years old. For more information about how NSW Trustee and Guardian will manage the payment, please visit the NSW Trustee and Guardian website or contact them directly.




Maximum 45 characters

Please enter the BSB number in the format 000-000 and select it from the list

Please select the financial institution from the list

Enter up to 9 numbers with no spaces


Maximum 45 characters

Maximum 95 characters

8-11 characters long

Maximum 9 characters

Maximum 35 characters

Maximum 45 characters

In this section you are asked to provide brief information about the act of violence or modern slavery. We understand this may be difficult. This information will help us consider your application.





Please ensure that the incident date(s) are the same as your existing application.






DD/MM/YYYY

DD/MM/YYYY

DD/MM/YYYY


If you don’t know the full address, please provide a suburb or town. If the incident(s) happened in more than one suburb or town, enter the suburb or town where most of the incident(s) took place.












Provide as much information as you can about the offender.





DD/MM/YYYY


If the offender is found guilty of the crime, they will be required to pay back Victims Services any money paid to you. For more information about restitution by offenders, visit the Victims Services website.

If you are applying for financial assistance and/or a recognition payment, further information and supporting documents need to be provided which include details about what happened and how the violent crime or modern slavery affected the applicant (or the child primary victim under 18, if applicable). This information is important and will assist us to process your application.

If the crime was reported to the police, you do not need to upload a copy of the police report. 

If you have a report from a government or government-funded organisation that the incident(s) was disclosed to, upload a copy of the report to this application.



If the incident(s) was not reported to the police or disclosed to a government or government-funded organisation, you may not be eligible for financial assistance for economic loss or a recognition payment.


DD/MM/YYYY

DD/MM/YYYY

DD/MM/YYYY


If the crime was disclosed to a government or government-funded organisation, please upload a report from that organisation. If the crime was reported to NSW police, you do not need to upload any documents.



Total size of all files uploaded to this form should not exceed 30MB



Total size of all files uploaded to this form should not exceed 30MB


COPS Event Number or SARO Reference Number






DD/MM/YYYY

If you are applying for a recognition payment, and do not have a copy of a medical, dental, or counselling report showing how you were affected as a result of the act of violence or modern slavery, you can send it to Victims Services within 12 months of submitting your application.

If you are claiming financial assistance for economic loss, such as loss of earnings, out-of-pocket expenses, or justice related expenses, you must upload at least one medical, dental, or counselling report showing how you were affected as a result of the act of violence or modern slavery. If you do not have a copy of the report, you can save the progress of your application and resume later within 30 days.

You can find more information about supporting documents and templates to help you collect the required information on the Victims Services website.




Total size of all files uploaded to this form cannot exceed 30MB.



Total size of all files uploaded to this form cannot exceed 30MB.



Total size of all files uploaded to this form cannot exceed 30MB.

Eligible persons can access up to 22 hours of counselling. Some victims may be eligible for more than 22 hours of counselling.



Financial assistance can be claimed for immediate needs to help cover the victim's urgent health, safety or wellbeing expenses, and for economic loss to help cover other expenses resulting from the incident(s). You can learn more about financial assistance categories and the supporting documents you need to provide on the Victims Services website.

Common claims for financial assistance include:

  • ambulance
  • anaesthetist
  • dentist
  • domestic assistance
  • essential household items
  • hospital fees
  • medication
  • physiotherapy or chiropractor
  • refuge accommodation
  • removalist or storage
  • rental assistance
  • security
  • surgery fees
  • travel to court.

You will need to provide receipts or itemised tax invoices to support your claims and provide a brief description about how each expense claimed is a direct result of the incident(s).


Applications for financial assistance must be submitted no later than 2 years after the incident(s), or within 2 years of turning 18 if the victim was a child at the time of the incident(s). There is no limit for victims of sexual assault to claim justice-related or out-of-pocket expenses if they were a child at the time the incident(s) occurred.

A total of 6 expenses can be submitted with this application. If you have additional expenses please complete the Claim for Expenses and email to vs@dcj.nsw.gov.au with your online application reference number.





You will also need to complete the Claim for Loss of Earnings and upload it to this application, along with the necessary supporting documents. Visit the Supporting documents page on the Victims Services website to learn more and download the claim form. If you're experiencing issues accessing the form from the Victims Services website, please right click the link and select ‘Open in a new tab’ or ‘Open in a new window’.


If you do not have the required documents, you can save the progress of your application and resume within 30 days.


The Immediate Needs Support Package is available for primary victims of domestic violence only.

You will also need to complete the Claim for Immediate Needs Support Package and upload it to this application, along with the necessary supporting documents.

If you do not have the required documents, you can save the progress of your application and resume within 30 days.



DD/MM/YYYY

$





If you have received a rebate from Medicare, a health fund or another organisation for the costs you are claiming, Victims Services will only reimburse the amount not covered by the rebate. If information regarding applicable rebates is not received, the expense may not be approved.


$


Please attach the following documents to your application:

  • copies of invoices, receipts or treatment plans 
  • evidence of Medicare or private health insurance rebates

You can add up to 6 expenses with your application.


Total size of all files uploaded to this form cannot exceed 30MB.

Recognition payments are made to eligible victims to acknowledge the trauma suffered. The maximum amount payable depends on the type of offence committed. Not all offences or acts of violence have recognition payment categories associated with them.

You must provide information about the police, government or government-funded organisation that the incident(s) was reported or disclosed to, and medical or dental or counselling reports to show how you were affected by the incident(s). To learn more about recognition payment categories and the supporting documents you need to provide on the Victims Services website.

If you don't provide your medical, dental or counselling report(s), you can send them to Victims Services within 12 months of lodging your application. If you do not give us your reports within 12 months, your application for a recognition payment will be closed.

If a recognition payment is approved while the applicant is younger than 18 years, the payment will be made to NSW Trustee and Guardian to hold until the applicant turns 18 years old. For more information about how NSW Trustee and Guardian will manage the payment, please visit the NSW Trustee and Guardian or contact them directly.


You have not selected which support type you would like to apply for!


You have not applied for a support type. An application can only be submitted if at least one support type is applied for.


Use the 'Previous Page' button to return to the first page to select the support types you want to apply for, this will determine which pages of the Application for Support you will see and need to complete.


Then, use the 'Next Page' button to continue to the relevant support page of the form and answer 'Yes' to the question 'Does the applicant want to apply for...'.


If you need assistance or are having trouble submitting your application, please contact the Victims Access Line on 1800 633 063 or the Aboriginal Contact Line on 1800 019 123.


If you are not ready to submit your application form, you can save the progress of your application and resume it later. Just click the 'Save my progress and resume later' button at the top or bottom of the form.

The applicant needs to tell us if they have received money from any other source because they were injured by the violent crime or modern slavery, or if the child victim has received money from any other source because they were injured. Please tell us about any money received, including money received from:

  • workers compensation
  • a civil or other court claim
  • insurance
  • the person who hurt you (or who hurt the child victim)
  • the owners of the place where you were hurt (or where the child victim was hurt), such as a hotel or club
  • compensation from a school or religious organisation
  • any individual, organisation or other source.

We cannot review your application until your workers compensation claim is finalised.

If the applicant has a legal representative for any of these matters, they may provide us with a letter from them which outlines the details and amount of the claim.











If you have any additional supporting documents, such as reports from a government or government funded organisation, medical reports or proof of money received from other sources you can attach them here.

Total size of all files uploaded to this form should not exceed 30MB


Total size of all files uploaded to this form should not exceed 30MB


Total size of all files uploaded to this form should not exceed 30MB

If you have additional supporting documents, you can send them to Victims Services via email or post after you submit your application. Ensure to include your application reference number.

The information that you give on this form is collected, used, held and disclosed by the Commissioner of Victims Rights  in accordance with the Department of Communities and Justice’s (DCJ’s) Privacy Policy for the purpose of administering the Victims Support Scheme and related functions under the Victims Rights and Support Act 2013. It is important you understand your privacy rights. For full information on how DCJ handles your information please call us on 1800 633 063 or visit the DCJ website. You can also contact us in writing by: 

  • Email: vs@dcj.nsw.gov.au
  • Post: Commissioner of Victims Rights, Victims Services, Department of Communities and Justice, Locked Bag 5118, Parramatta, NSW, 2124

 


The information you provide on your application form is very important to support your claim. If you would like to change the information that you have provided, please contact Victims Services. The applicant must declare the following to complete the application, unless they are under 18 years of age or otherwise lack the legal capacity to make the declaration. If the applicant is under 18 years of age, or lacks the capacity to complete the application, then a parent, step-parent or guardian may agree to be bound by the declaration on the victim’s behalf.

The information that you give on this form is collected, used, held and disclosed by the Commissioner of Victims Rights  in accordance with the Department of Communities and Justice’s (DCJ’s) Privacy Policy for the purpose of administering the Victims Support Scheme and related functions under the Victims Rights and Support Act 2013. It is important you understand your privacy rights. For full information on how DCJ handles your information please call us on 1800 633 063 or visit the DCJ website.

Declaration

I state the following and acknowledge these declarations apply to all claims I make under this Application for Support:

A. The truth, collection and disclosure of information


A1. I declare that the information provided in this application is true and correct.

A2. I understand that giving false or misleading information is a serious offence and may
adversely affect the outcome of my victims support application and lead to criminal and/or
civil legal action against me.

A3. I confirm that I have read the Department's Privacy Policy and documents referred to therein, and agree to the collection, use and sharing of information as outlined in those documents.

A4. I consent to and authorise the Commissioner of Victims Rights or their delegate (the
Commissioner), to disclose personal and health information to verify the information
provided, including to State and Commonwealth government agencies and authorities and/or as required by law.

     B. Keeping Victims Services up-to-date


B1. I understand that I am required by law to notify the Commissioner if any of my
circumstances change after completing this form, as it may affect my eligibility for support.

B2. I understand that it is my responsibility to update the Commissioner with any changes to my personal details in this form, including but not limited to my name, contact details, and bank account information.

     C. Accepting payments of Victims Support


C1. I understand that if victims support is approved, action may be taken (restitution) to
recover money from a person convicted of a crime for which the support relates.

C2. I understand that if victims support is approved, I am subject to the conditions set out at
section 48 of the Victims Rights and Support Act 2013, and I am required to notify the
Commissioner if I receive, or have received a payment from another source, in connection
with the act of violence or modern slavery. I will be required to repay victims support if this
occurs.

C3. If victims support is approved, payment will be deposited to the bank account detailed in this form, unless an updated account has been supplied and confirmed as received by the Commissioner.

C4. I will keep proof of my purchases and I will produce evidence of my expenses on request if this is a condition of payment.

     D. Authorising a representative  


D  D1. If I have authorised someone to be my representative, I understand that:


      D1.1. by giving this authority, the Commissioner can get information from and provide

information to my authorised representative for the purposes of my application(s)

D1.2. if my authorised person is a representative of a support service or law firm, this authority extends to that organisation

D1.3. my authorised representative must provide my written instructions to update my
personal details, including contact details and bank account details

D1.4. my authorised representative must provide my written instructions to withdraw my
application(s)

D1.5. any previous authorised representative(s) will no longer be able to act or enquire on my behalf, unless they are my parent or guardian.

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