Justice Home > Victims Services

Forms

NOTE:
The online application, and some of the other PDF forms on this page, are not compatible with all PDF readers. Tablets, smartphones (e.g. iPhones and Android) and some browser plugins (e.g. MacOS, recent versions of Firefox) are known to have problems. Victims Services is looking into this. If you are having difficulties using Chrome to download the form you may wish to use Internet Explorer instead. Alternatively, you can save a copy of the downloadable form and use Adobe Reader to fill it in or call Victims Services on 1800 633 063 will assist with filling in the form for you.


     

    Counselling and/or financial assistance and/or recognition (online form)

    Counselling and/or financial assistance and/or recognition payment (online form)

    The online application form:

    • provides options to apply for an initial 10 hours counselling &/or for financial assistance &/or for a recognition payment.

    • allows you to complete the form online or offline and submit when you are ready to complete

    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 the top of a submitted form.

    Support for primary victims

    Application for support for primary victims (PDF, 293Kb)
    (8pp form)

    If you wish to apply for counselling, financial assistance for immediate needs, and/or financial assistance for economic loss, and/or a recognition payment but are unable to use the online application above, you can complete and return this form.

    Counselling only

    Application for counselling (PDF, 125Kb)
    (2pp form)

    If you wish to apply for counselling only but are unable to use the online application above, you can complete and return this form.

    Support for a family member of a homicide victim

    Application for support for a family member of a homicide victim (PDF, 187Kb)
    (4pp form)

    If you are a family member of a homicide victim and wish to apply for counselling, financial assistance for immediate needs, and/or financial assistance for economic loss, and/or a recognition payment but are unable to use the online application above, you can complete and return this form.

    Financial support for family members of homicide victims (pdf 115Kb)
    (2pp A4 sheet)

    This guide will assist you to understand your entitlements to victims support under the Victims Rights and Support Act 2013.

    Family members of homicide victims (pdf 165Kb)
    (brochure)

    Outlines ways Victims Services can assist with counselling, payment of funeral expenses and financial support for family members of a homicide that occurred in NSW. 

    Miscellaneous

    Charter of Victims Rights complaint form (PDF 257Kb)
    4pp form

    Information about making a complaint under the Charter of Victims Rights (PDF 164Kb)
    2pp guide

    The Charter of Victims Rights sets out 18 rights which outline how government departments should treat and assist you if you are a victim of crime. Victims Services has a responsibility to receive complaints and to try to resolve th​em. The Charter Complaints webpage explains what you can do if you feel that your rights have not been met.

    Information on requesting an internal review (PDF, 114Kb)
    (2pp form)

    If you received a decision from Victims Services regarding an application for victims support that you disagree with you can request an internal review of the decision by filling out this form.

    Authorising a person to enquire or act on your behalf (PDF, 86Kb)
    (1pp form)

    Use this form to authorise someone to act on your behalf, to make enquiries and to receive written communication in relation to an application.

    Medical information release form (PDF, 121Kb)
    (1pp form)

    Use this form to hereby give consent for Victims Services to contact health professional/s listed to obtain any reports, clinical notes or other relevant medical information to determine any entitlement to support.

    Restitution

    Have you been convicted of an offence? You may have to pay restitution (PDF 190KB)
    (DL brochure)

    Notice of objection to a provisional order of restitution (PDF, 77Kb)
    (1pp form)

    Affidavit of financial circumstances (PDF, 103Kb)
    (2pp form

    Application to pay amount of restitution by arrangement or by instalments (PDF, 148Kb)    
    (2pp form)

    Restitution payment options application (PDF, 119Kb)
    (1pp form)

    Direct Credit Authority (PDF, 107Kb)
    (1pp form)

    If you have difficulty downloading any forms please contact Victims Services.

    All our forms require Adobe Reader (8.01 or above) to be installed on your computer. The free Adobe Reader software can be downloaded from the Adobe website.