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    • Victims of Crime QLD - Have you been a victim of crime? You may be entitled to victims assistance from QLD Government.
    Quick Contact
    Full Name
    Address
    Safe Address
    Phone Number
    Email Address
    Incident Description
    Incident Date & Location
    Were you injured in Queensland?
    Yes No
    Were you injured in the last 3 years?
    Yes No
    Was it reported to the Police?
    Yes No
    Did you receive medical treatment?
    Yes No
    Security Code
    		  

    Victims of Crime Queensland


    Complete this victims of crime enquiry form if you have been a victim of crime in Queensland during the past two years and have reported the incident to the police.

    Victims of crime in Australia are entitled to financial compensation and support to assist them to recover from the act of violence, including cash lump sum payments for pain and suffering.

    Please complete this form with as much detail as you are able to provide and we will contact you promptly.


    Enquiry Form


    Fields marked with * are mandatory.
    Personal Details
    Full Name * Date of Birth
    Address * Phone *
    Safe Address  Email *
     
    Incident Details
    Descrbibe incident in details *
    Incident date & location Police statement & police details
    Offenders details Other victims
     
    Injuries Sustained & Treatment
    List physical injuries & treatment
    List psychological injuries & treatment
     
    Out Of Pocket Expenses
    Indicate any of the following expenses:

    Medical, dental, ambulance, hospital, pharmaceutical, loss of income, physiotherapy, psychiatric, psychological, damage to clothing, improved home security, moving home, travelling, other.
    List Expenses
     
    Other Relevant History
    Prior trauma history Prior medical or psychiatric history
    Other comments