t? Please supply and attacll details of any relevant insurance cover ife or hea h) or superannuation bener be entitlements held and any payments daimed, received or to received • 0 0 By the applicant provide detailS By the deceased provide details 8.TYPE OF ASSISTANCE SOUGHT 0 (a) Primary Victim Special Financial Assistance (limp sumpayment for signiftcanl adverse effects suffered) 0 Counselling 0 MedicalE.xpenses 0 saretyR· elated Expenses 0 Loss of Earning 0 Loss/Damage to clothing 0 Other 0 Counselling (b) Secondary Victim 0 MedicalExpenses 0 Loss of Earnings • 0 Other• 0 (c) Related Victim Distress 0 FuneralExpenses 0 Counselling 0 MedicalExpenses 0 Other • 0 (d) Application for payment of funeral expenses only of exceptional circumstances may be required. •Evidence Page 4 of 16 May2:0·16
t? Please supply and attacll details of any relevant insurance cover ife or hea h) or superannuation bener entitlements held and any payments daimed, received or to be received • By the applicant 0 provide detailS By the deceased 0 provide details 8.TYPE OF ASSISTANCE SOUGHT (a) Primary Victim 0 Special Financial Assistance (limp sumpayment for signiftcanl adverse effects suffered) 0 Counselling 0 MedicalE.xpenses 0 saretyR· elated Expenses 0 Loss of Earning 0 Loss/Damage to clothing 0 Other (b) Secondary Victim 0 Counselling 0 MedicalExpenses 0 Loss of Earnings • 0 Other• (c) Related Victim 0 Distress 0 FuneralExpenses 0 Counselling 0 MedicalExpenses 0 Other • (d) Application for payment of funeral expenses only 0 •Evidence of exceptional circumstances may be required. Page 4 of 16 May2:0·16
VLRC_Victims_of_Crime_Assistance_Act_Supplementary_Consultation_Paper.docx