Victims of Crime Assistance (Procedure) Rules 2007

i Victims of Crime Assistance (Procedure) Rules 2007 S.R. No. 43/2007 TABLE OF PROVISIONS Rule Page 1 Object 1 2 Authorising provisions 1 3 Commencement 1 4 Application—Form 1 1 5 Lodgement 1 6 Application may be lodged by fax 2 7 When application made 3 8 Venues of the Tribunal 3 __________________ Form 1—Application for assistance 4 ═══════════════ -- 1 of 10 -- 1 STATUTORY RULES 2007 S.R. No. 43/2007 Magistrates' Court Act 1989 Victims of Crime Assistance (Procedure) Rules 2007 The Chief Magistrate together with 2 Deputy Chief Magistrates jointly make the following Rules: 1 Object The object of these Rules is to prescribe a form of application and to specify certain procedures for the purposes of facilitating applications to the Victims of Crime Assistance Tribunal under the Victims of Crime Assistance Act 1996. 2 Authorising provisions These Rules are made under section 57 of the Victims of Crime Assistance Act 1996 and all other enabling powers. 3 Commencement These Rules come into operation on 1 July 2007. 4 Application—Form 1 For the purposes of section 26 of the Act, the prescribed form of application is in Form 1. 5 Lodgement (1) Unless subrule (2) applies, an application to the Tribunal must be lodged with or posted to a registrar of the Tribunal at the venue of the Tribunal that is closest to the applicant's place of residence, or if there is more than one applicant in relation to an act of violence and they are not -- 2 of 10 -- S.R. No. 43/2007 Victims of Crime Assistance (Procedure) Rules 2007 2 close family members, at the venue of the Tribunal that is closest to the act of violence. (2) An application to the Tribunal must be lodged with or posted to the registrar of the Tribunal at Melbourne if— (a) the applicant resides outside the State; or (b) the applicant is a related victim; or (c) the applicant is— (i) a primary victim; or (ii) a secondary victim; and— is aware of the existence of a related victim with respect to the act of violence that is the subject of the application. (3) Despite subrules (1) and (2), a registrar of the Tribunal may accept an application lodged with or posted to a registrar of the Tribunal at a venue of the Tribunal other than a venue determined in accordance with those subrules . 6 Application may be lodged by fax (1) An application may be lodged with a registrar of the Tribunal by fax in accordance with this Rule. (2) An application lodged by fax must include a cover page stating— (a) the name, address and telephone number of the sender; (b) the date and time of transmission; (c) the total number of pages sent, including the cover sheet; (d) the telephone number from which the application is sent; r. 6 -- 3 of 10 -- S.R. No. 43/2007 Victims of Crime Assistance (Procedure) Rules 2007 3 (e) the name and telephone number of a person to contact in the event of any problem in faxing the application; (f) that the fax is by way of lodgement under Rule 6(1). (3) A copy of an application lodged by fax must be lodged with the registrar of the Tribunal within 14 days after the fax was sent. (4) Unless a copy of the application is lodged in accordance with subrule (1), the application must be deemed to have been struck out. 7 When application made (1) An application is made when it is received by the registrar of the Tribunal in accordance with Rules 5 or 6. (2) The registrar, on receipt of an application, must note the date of receipt of such application on the application. 8 Venues of the Tribunal Each venue of the Magistrates' Court is a venue of the Tribunal. __________________ r. 7 -- 4 of 10 -- S.R. No. 43/2007 Victims of Crime Assistance (Procedure) Rules 2007 4 FORM 1 Rule 4 APPLICATION FOR ASSISTANCE (Victims of Crime Assistance (Procedure) Rules 2007) Victims of Crime Assistance Tribunal Ref. no. DETAILS OF PERSON WANTING ASSISTANCE Surname— Given names— Address— Postcode— Telephone (H)— (W)— Occupation— Date of Birth— Sex Male ❏ Female ❏ *Are you of Aboriginal or Torres Strait Islander origin? (Persons of both Aboriginal and Torres Strait Islander origin should mark both "Yes" boxes) No ❏ Yes, Aboriginal ❏ Yes, Torres Strait Islander ❏ *NOTE: This information will enable the Tribunal to provide you with information to assist your application. Have you previously made an application for assistance or compensation under this Act? Yes ❏ No ❏ Have you previously made an application in respect of this act of violence? Yes ❏ No ❏ Please nominate which category applies to you— 1. Primary Victim ❏ 2. Secondary Victim ❏ 3. Related Victim ❏ Form 1 -- 5 of 10 -- S.R. No. 43/2007 Victims of Crime Assistance (Procedure) Rules 2007 5 4. Application for payment of funeral expenses ❏ PLEASE NOTE YOU CAN ONLY APPLY IN ONE CATEGORY PLEASE COMPLETE THIS SECTION IF YOU ARE MAKING THIS CLAIM ON BEHALF OF A CHILD Your full name— Address— Postcode— Telephone— Date of birth— Relationship to applicant— CIRCUMSTANCES OF THE ACT OF VIOLENCE What was the act of violence/offence?— Where did the act of violence occur?— Date of act of violence— Time— am❏ pm❏ Who committed the act of violence?— Sex of alleged offender Male ❏ Female ❏ *Was the alleged offender a family member or domestic partner of the victim? Yes ❏ No ❏ If Yes, how are you related to the offender? I am their— (eg: wife, son, father, step-sister, former domestic partner) *NOTE: This information is for data collection purposes only. POLICE REPORTING DETAILS Has the act of violence been reported to the Police? Yes ❏ No❏ If Yes, please provide the officer's details— Name— Registered number— Rank— Police station— Form 1 -- 6 of 10 -- S.R. No. 43/2007 Victims of Crime Assistance (Procedure) Rules 2007 6 Date of report— If the act of violence was not reported, you must provide a statutory declaration setting out the circumstances of the act of violence and provide the reason for the failure to report the matter. Have criminal proceedings commenced?— Yes ❏ No ❏ Unknown ❏ If known, provide any details known to you (ie. date and location of hearing)— WHAT EFFECTS HAVE RESULTED FROM THE ACT OF VIOLENCE? Physical* Yes ❏ No ❏ Psychological* Yes ❏ No ❏ Grief, distress or trauma Yes ❏ No ❏ Provide details— *A medical or psychological report should be filed with the registrar of the Tribunal Did you attend a public hospital? Yes ❏/No ❏ If yes, what hospital?— ARE YOU APPLYING FOR ASSISTANCE FOR— Primary Victim ❏ Special financial assistance ❏ Counselling ❏ Medical expenses ❏ Loss of earnings ❏ Loss or Damage to clothing ❏ Other* Secondary Victim ❏ Counselling ❏ Medical expenses ❏ Loss of earnings* ❏ Other* Form 1 -- 7 of 10 -- S.R. No. 43/2007 Victims of Crime Assistance (Procedure) Rules 2007 7 Related Victim ❏ Distress ❏ Counselling ❏ Medical expenses ❏ Funeral expenses ❏ Other* ❏ Funeral expenses only *Proof of exceptional circumstances may be required HAVE YOU APPLIED FOR ASSISTANCE UNDER ANY OTHER SCHEMES? Still Pending Refused Amount Received Reference or claim number ❏ WorkCover ❏ ❏ $ ❏ Transport Accident Commission ❏ ❏ $ ❏ Insurance ❏ ❏ $ ❏ Other ❏ ❏ $ Please provide details of a claim under any of these schemes— Please supply and attach details of any relevant insurance cover (life or health) or superannuation benefit entitlements held and any payments received or to be received— by the applicant— by the deceased— IF DEATH WAS CAUSED BY THE ACT OF VIOLENCE Full name of deceased— Last known address Postcode Date of birth Relationship to applicant Date and place of death NOTE: YOU MUST ALSO COMPLETE THE RELATED VICTIMS PART OF THIS FORM Form 1 -- 8 of 10 -- S.R. No. 43/2007 Victims of Crime Assistance (Procedure) Rules 2007 8 DETERMINATION OF YOUR APPLICATION Would you prefer to: ❏ Attend a hearing at the Tribunal? OR ❏ Have your application determined in your absence? Do you request that: ❏ Proceedings be conducted in a closed Court? ❏ Publication of your application be restricted? Do you require an interpreter? Yes ❏ /No ❏ If yes, specify a language— THIS SECTION IS TO BE COMPLETED BY RELATED VICTIM APPLICANTS As a related victim you are required to list— (a) every other person whom you believe may be a related victim; and (b) every other person whom you believe may allege that he or she is a related victim; and (c) any person whom you believe may apply because they have incurred funeral expenses as a result of the death of the primary victim. Name of potential victim: Age of potential victim if under 18 years of age: Address of potential victim*: Relationship of potential victim to the deceased: *If the potential victim is under 18 years of age, provide the name and address of parent, guardian or administrator (Attach a separate sheet if required) Signature of applicant— AUTHORISATION OF APPLICANT I authorise the Victims of Crime Assistance Tribunal to obtain any additional evidence or documentation that the Tribunal considers necessary to enable it to determine my application. Signature of applicant— Form 1 -- 9 of 10 -- S.R. No. 43/2007 Victims of Crime Assistance (Procedure) Rules 2007 9 STATUTORY DECLARATION I (name and occupation) of (address) do solemnly declare that the contents of this application are true and correct and I make this solemn declaration conscientiously believing that a person making a false declaration is liable to the penalties of perjury. Signature of applicant— Declared at— Date— Before me— Signature of person witnessing the declaration— Name of witness— Title of witness— Address of witness— Dated: 30 May 2007 IAN GRAY, Chief Magistrate PETER LAURITSEN, Deputy Chief Magistrate JELENA POPOVIC, Deputy Chief Magistrate ═══════════════ Form 1 -- 10 of 10 --