Forms for financial assistance

Financial Assistance Scheme Forms

The application forms are available on this page. Please select the form that applies to your situation.

Important note: Please download and save application forms before completing them. If the form is completed before it is downloaded, information entered will not be saved.

You can also print the form and complete it by hand.

If you have receipts or quotes for things you would like us to pay for, please include these with your application.

If you need help to complete the form, we can provide that, please contact us.

Primary victim form

You are a primary victim if you have been injured emotionally or physically by a violent crime in the ACT.

Primary Victim Application Form PDF(501KB)

Guide to completing the primary victim application form PDF(349KB) Word(101KB)

Related victims and homicide witnesses form

You are a related victim if you are a family member or dependant of a victim who has died as a result of a crime.

If you were injured as a result of witnessing a death as a result of a crime, you can apply for financial assistance for immediate needs and/or financial assistance for economic loss.

Guide to Completing the Related Victim or Homicide Witness Application Form Word(95KB)

Funeral assistance form

If you are required to pay for a funeral for a homicide victim, you can apply for a funeral expense payment.

Funeral Assistance Application Form PDF(141KB)

Guide to Completing the Funeral Assistance Application Form PDF(252KB) Word(71KB)

Other forms

Application to Vary Amount of Financial Assistance WORD(75KB)

Use this form to apply for a variation on the amount of financial assistance you have received if your circumstances have changed, or are likely to change, since you received the earlier assistance payment.

Supporting documents

The things we need to decide your application are:

evidence that the crime happened to you
evidence that you were injured
proof of your expenses

The things we need from you are:

consent to contact support services who have assisted you in relation to the crime
consent to contact professionals who you have treated you in relation to the crime
letters or medical certificates confirming you were injured by the crime
copies of invoices or quotes for expenses you are claiming.

To get evidence that the crime happened to you, we usually ask police for records they have about the crime.

Submitting Applications

Applications can be submitted by:

Email: fasvsact@act.gov.au

Post: Financial Assistance Scheme, Victim Support ACT

GPO Box 158

Canberra ACT 2601

In person: ACT Human Rights Commission

56 Allara Street

Canberra City