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Forms



Online forms

Note: Online Forms are compatible with Google Chrome, Mozilla Firefox and Internet Explorer 11 or greater. If you are experiencing issues accessing our online forms or do not have access to a compatible web browser please click here.

Application form for Primary Victims (online)

Application form for Counselling (online)

Application form for Support for a Family Member of a Homicide Victim (online)

Application form for funeral expenses by a funeral director (online)

Application form for forensic cleaning expenses (online)

Application forms - PDF versions

Funeral expenses by a funeral director (PDF, 76kb)

Funeral expenses by a funeral director – fillable (PDF, 117kb)

Forensic cleaning expenses (PDF, 76kb)

Forensic cleaning expenses – fillable (PDF, 117kb

Immediate needs support package

Immediate needs support package - Fact sheet & form (PDF, 184Kb)

Use this form to apply for a grant to help pay for costs needed urgently following domestic violence.

You need to attach this to your online Application for support for primary victims, or send it as a hardcopy along with the PDF version of the Application for support for primary victims.

Templates for collecting information to support your application

How to collect information to support your application (PDF, 75kb)

Use this guide to find out how you can use the templates below to collect information to support your application for victims support.

Certificate of Injury (PDF, 69kb)

Certificate of Injury – fillable (PDF, 105kb)

Use this template to collect information about how the violent crime has affected you physically or psychologically/emotionally. Ask your medical practitioner or other health practitioner to fill out this template.

Certificate of Earnings (PDF, 448kb)

Use this template to collect information about how you were unable to work because of the violent crime. Ask your employer to fill out this template.

Expense Form (PDF, 439kb)

Use this form to claim new costs related to the violent crime, only if you have already submitted an application form. The Expense Form should only be used for new costs on existing applications.

If you have not already submitted an application for victims support, you can do this online at https://www.victimsservices.justice.nsw.gov.au/Pages/vss/VS_forms.aspx.

Government-funded organisation report (PDF, 120kb)

Use this template to collect information about the violent crime if you reported it to a government or government-funded organisation instead of the police. Ask the government or government-funded organisation to fill out this template. This template may be used to support victim claims made after 14 January 2019.

Miscellaneous

Service Complaints Form (online)

Charter of Victims Rights Complaints Form (online)

Charter of Victims Rights Complaints Form (PDF, 257kb)

Information about making a complaint under the Charter of Victims Rights (PDF, 164kb)

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

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

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.

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, 73Kb)
(1pp form)

Affidavit of financial circumstances (PDF, 209Kb)
(3pp form)

Restitution payment options
(PDF, 107Kb)

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.