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Victims of Crime Compensation Form

Client information for a possible compensation claim

How this works. Complete the form below on your phone or computer and tap Submit. It is sent straight to East End Legal. Fields marked * are required. You will not be able to attach documents here — email copies (not originals) to faros@eastendlegal.com.au or bring them to your appointment. This form is prepared by East End Legal for its clients; it is not a government form.
If you or a child are in immediate danger, call 000.

Part 1 - Your details

Thank you for engaging East End Legal in connection with a possible claim for compensation as a victim of crime. Please complete as fully as you are able — it helps us assess your position and prepare your application. What you tell us is protected by our duty of confidentiality and, where it applies, legal professional privilege.

Preferred contact
Safe to leave a message?

Part 2 - Details of the offence

e.g. assault, sexual assault, robbery
If known
If any - e.g. partner, stranger, family member
Was the offender charged?

Part 3 - Injuries and impact

Ongoing symptoms or disability?

Part 4 - Medical treatment

Please do not enter your Medicare number; we will ask for it later if needed.

Ambulance attended?

Part 5 - Financial losses

Approximate figures are fine.

e.g. travel to appointments, replacing damaged property
e.g. WorkCover, insurance, National Redress Scheme

Part 6 - Witnesses

Documents and declaration

Documents you will send or bring (copies only)

I declare that the information in this form is true to the best of my knowledge. I understand that this form is prepared by East End Legal for its clients and is not a government form, that completing it does not mean East End Legal has agreed to act for me, and that time limits apply to claims of this kind. I consent to East End Legal using this information to assess and prepare my application, in accordance with its Privacy Statement.

Your answers are sent securely over HTTPS to East End Legal’s mailbox. Email is not completely secure, so please do not type passwords, card numbers or ID numbers into this form.