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Forms for financial assistance from Victim Assist

Victim Assist Queensland provides access to services and financial assistance to help victims of violent crime recover from the act of violence, including domestic and family violence.

You can apply for our help if the act of violence happened in Queensland. If you have been a victim of violence in another country, state or territory, we can refer you to the relevant jurisdiction’s service.

If you have not already done so, read about what assistance is available and who can apply and how to apply.

It is an offence under the Victims of Crime Assistance Act 2009 to make a statement or provide a document that is false or misleading. We do not tolerate fraud and instances of suspected fraud are investigated and prosecuted as appropriate. If you suspect a person has provided false or misleading information to Victim Assist Queensland, you can report this to Police Link or your local police station.

Download a financial assistance application form

Primary victim application form

A primary victim is a person who has been directly injured by an act of violence in Queensland.

Parent secondary application form

The parent secondary application is for a parent of a child or young person under 18 who has been injured by an act of violence in Queensland.

Witness application form

The witness application form is for a witness who has seen or heard an act of violence committed in Queensland.

Related victim application form

A related victim is a close family member, or financial dependant, of a person who has died as a direct result of an act of violence that has happened in Queensland (e.g. homicide or dangerous driving causing death).

Funeral assistance application form

Funeral assistance might be available for the person responsible for the cost of a funeral for a person who has died as a direct result of an act of violence that has happened in Queensland (e.g. homicide or dangerous driving causing death).

Verification of identity

We need to be certain the right person receives financial assistance. If applying for financial assistance, complete this form, have it witnessed and include it with your application form.

You can also use this form to let us know about any changes to your contact or banking details.

Optional medical certificate

Medical information from a health practitioner may be needed if you are claiming medical or counselling expenses. This form may also be used to confirm the act of violence resulted in an injury. If you have existing medical information, you may not need to have this form completed; you can send a copy of other relevant information with your application.

Special applicants

Child or young person (under 18)

The application form needs to be completed by your parent or legal guardian.

If your parent or legal guardian is unable or unwilling to complete the form (including if you are under the care of Child Safety Services), contact us for advice.

If you are more than 12 years and you would like to apply independently, a lawyer can help you with your application. Contact us and we can refer you to a free legal service.

Adult with impaired capacity

If a substituted decision maker has been appointed, such as a guardian, administrator or power of attorney, they should complete the form on your behalf.

If no substituted decision maker has been appointed, but you would like help to complete your form, contact us. We can refer you to a free service to help you complete your application yourself.

Find out more

Quick exit to

Contact Victim Assist

Complete our online information request.


Phone: 1300 546 587 (business hours)

Check your existing application.

Interpreter assistance

Phone: 13 14 50

Hearing impaired assistance

TTY users phone: 13 36 77 (no additional call charges apply)

Speak and listen (speech-to-speech relay) users phone: 1300 555 727

Internet relay users connect to the National Relay Service.

Hints and tips for completing forms

Make sure you have the right form—read the top of page 1.

We don't need a lot of details about what happened. We will ask the police to provide a detailed report.

It's okay to write things like 'I need to see a counsellor' or 'My doctor has prescribed medication'. We will ask your health practitioner to give us a detailed treatment plan.

Don't forget to sign the last page. You can sign electronically if you prefer.

Remember to save a copy of your form.

Contact us if you need help to complete your form.

Last updated
4 July 2018
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