Forms - Application Forms for Compensation and Counselling

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Forms - Application Forms for Compensation and Counselling Online application for Compensation and/or Initial 2 Hour Counselling and/or Prescribed Expenses[ Start your online application (form will open in a new window) To use the online interactive form you will need to have Adobe Reader (8.01 or above) installed on your computer. The Adobe reader can be installed free at the Adobe website. At the end of the form you are asked to press a SUBMIT button which will send the application to Victim Services. If the submission process has been successful you will see on your screen a copy of the form with an enquiry number near the top. See sample image of a submitted form Features of the online application form: The one form allows you to apply for compensation and/or initial 2 hour counselling and/or prescribed expenses under the Victims Assistance Scheme You can complete the form online or offline and submit when you are ready to complete Information and help functions will assist you to complete the form Only those parts of the form that relate your personal circumstances need to be completed Intuitive ‘body’ makes it easier for you to select injury After you submit the form you will be given a receipt number and copy of the form in your browser window. This online form is only available for primary and secondary victims. Family members of homicide victims will need to select the appropriate form below. Other Forms Family Member of Homicide Victim Application for Counselling by a Family member of a Homicide Victim Online counselling form Application for Counselling by a Family member of a Homicide Victim – pdf (135Kb) version to download, complete and then send via email, mail or fax. Application for Compensation by a Family Member of a Homicide Victim (pdf 135Kb) Application for Funeral Expenses (pdf 67Kb). This form is to be used if you are applying for funeral expenses only. If you are applying for compensation and funeral expenses you only need to complete the Application for Compensation by a Family Member of a Homicide Victim Counselling for primary/secondary victim Application for 2 hours counselling - (pdf 71 Kb) version to download, complete and then send via email, mail or fax Further Counselling for primary/secondary or family victim Request for Further Hours of Approved Counselling - secure online form - can be completed and submitted online Request for Further Hours of Approved Counselling - non-encrypted online form - for persons who have difficulties accessing the secure version above Request for Further Hours of Approved Counselling - doc version (11Kb) - download, complete and then send via email, mail or fax Compensation (These forms cannot be submitted online. See above for online form) Application for Compensation and/or Expenses (pdf 196Kb) After downloading, you need to complete, then print, have signed, and then post or fax to Victims Services. Injury Nomination Bridging form (PDF 62KB) - for nominating compensable injuries where no nomination was made in the original application for compensation Consent Consent Form (pdf 21Kb) – to be used for authorising a person to enquire or act on your behalf. Restitution Forms (for defendants) Defendants who need to pay monies to Victims Services because of a compensation award to a victim can find the forms they need in the Recovering Money section. Select this link to view All Our Publications If you have any difficulty downloading any forms please contact Victims Services.

Last updated: 9 December 2009

Online application for Compensation and/or Initial 2 Hour Counselling and/or Prescribed Expenses[

Other Forms