Victims of Crime Assistance (Procedure) Rules 1997

i Victims of Crime Assistance (Procedure) Rules 1997 S.R. No. 64/1997 TABLE OF PROVISIONS Rule Page 1. Object 1 2. Authorising provision 1 3. Commencement 1 4. Form of application—Form 1 1 5. Lodgement 1 6. Venues of the Tribunal 2 7. Appropriate venue 3 8. When application made 3 9. Notification to Tribunal by applicant who is a related victim— Form 2 3 10. Notification to potential related victim—Form 3 3 Form 1—Victims of Crime Assistance Tribunal 4 Form 2—Related Victims Information Notice 9 Form 3—Notice to Person with Possible Right to Apply 11 ═══════════════ -- 1 of 13 -- 1 STATUTORY RULES 1997 S.R. No. 64/1997 Victims of Crime Assistance Act 1996 Victims of Crime Assistance (Procedure) Rules 1997 The Chief Magistrate together with 2 or more Deputy Chief Magistrates jointly make the following Rules: 1. Object The object of these Rules is to prescribe certain matters and to specify certain procedures for the purposes of the Victims of Crime Assistance Act 1996. 2. Authorising provision 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 1997. 4. Form of application—Form 1 The prescribed form of application under section 26 of the Act is Form 1. 5. Lodgement Unless the Tribunal otherwise orders, an application or any other document required by the Act or these Rules cannot be lodged with the Tribunal by facsimile transmission. -- 2 of 13 -- S.R. No. 64/1997 Victims of Crime Assistance (Procedure) Rules 1997 2 6. Venues of the Tribunal The following venues of the Magistrates' Court are venues of the Tribunal— Ararat Bairnsdale Ballarat Bendigo Broadmeadows Dandenong Echuca Frankston Geelong Hamilton Heidelberg Horsham Kerang Melbourne Maryborough Mildura Moe Portland Ringwood Sale Shepparton Swan Hill Wangaratta Warrnambool. r. 6 -- 3 of 13 -- S.R. No. 64/1997 Victims of Crime Assistance (Procedure) Rules 1997 3 7. Appropriate venue (1) Except as paragraph (2) otherwise provides, an application must be lodged with, or posted to, the registrar of the Tribunal at the venue of the Tribunal closest to where the applicant resides. (2) If the applicant resides outside Victoria or is in the care of the Department of Human Services, an application must be lodged with, or posted to the registrar of the Tribunal at Melbourne. 8. When application made (1) An application is made when it is received by the registrar of the Tribunal at the venue of the Tribunal determined in accordance with Rule 7. (2) The registrar, on receipt of an application, must note the date of receipt of such application on the application. 9. Notification to Tribunal by applicant who is a related victim—Form 2 Subject to and in accordance with section 30 of the Act, notification to the Tribunal by an applicant who is a related victim is in accordance with the rules if it is in Form 2. 10. Notification to potential related victim—Form 3 The registrar of the Tribunal may send a notification to a person in Form 3 if the registrar is of the opinion that the person may have an entitlement to make application to the Tribunal. __________________ r. 7 -- 4 of 13 -- S.R. No. 64/1997 Victims of Crime Assistance (Procedure) Rules 1997 4 FORMS Form 1 Rule 4 APPLICATION FOR ASSISTANCE (Victims of Crime Assistance (Procedure) Rules 1997) Victims of Crime Assistance Tribunal Ref. no. DETAILS OF THE PERSON WANTING ASSISTANCE Surname________________Given names__________________ Address___________________________Postcode___________ Telephone(H)__________________(W)___________________ Occupation____________________Date of Birth____________ Have you previously made an application for assistance/compensation under this Act? Yes/No Have you previously made an application in respect of this criminal act? Yes/No Please nominate which category applies to you? 1. Primary Victim ❏ 2. Secondary Victim ❏ 3. Related Victim ❏ 4. Application for payment of funeral ❏ expenses IF YOU ARE MAKING THIS CLAIM ON BEHALF OF A CHILD Your full name_______________________________________ Address________________________________Postcode______ Telephone________________Date of Birth________________ Relationship to applicant_______________________________ Form 1 -- 5 of 13 -- S.R. No. 64/1997 Victims of Crime Assistance (Procedure) Rules 1997 5 CIRCUMSTANCES OF THE CRIMINAL ACT What was the criminal act/offence?________________________ Where did the criminal act occur?_________________________ Date of criminal act_________________Time_________am/pm Who committed the criminal act?_________________________ POLICE REPORTING DETAILS Has the criminal act been reported to the Police? Yes/No If so, please provide the officer's details: Name__________________________Registered no._________ Rank________Police station_________Date of report________ If the criminal act was not reported, explain why?___________ ___________________________________________________ Have criminal proceedings commenced? Yes/No/Unknown If known, provide any details known to you (ie. date and location of hearing)__________________________________________ ___________________________________________________ INJURIES RECEIVED What type of injuries did you receive as a result of the incident? Physical Yes/No Psychological Yes/No Provide details_______________________________________ ___________________________________________________ ___________________________________________________ Did you attend a hospital? Yes/No If so, what hospital/s?__________________________________ WHAT AMOUNT AND TYPE OF ASSISTANCE ARE YOU SEEKING? Amount $ Type of assistance sought ––––––––––––––––––––––––––––––––– ––––––––––––––––––––––––––––––––––––––––––––––––––––– Form 1 -- 6 of 13 -- S.R. No. 64/1997 Victims of Crime Assistance (Procedure) Rules 1997 6 ARE YOU APPLYING FOR ASSISTANCE FOR: Counselling ❏ Medical expenses ❏ Loss of earnings ❏ Loss/Damage to clothing ❏ Funeral expenses ❏ Other ❏ HAVE YOU APPLIED FOR ASSISTANCE UNDER ANY OTHER SCHEMES? Still Pending Refused Amount Received Ref./Claim No. ❏ Workcover ❏ ❏ $_____ _________ ❏ Transport Accident Commission ❏ ❏ $_____ _________ ❏ Insurance ❏ ❏ $_____ _________ ❏ Other ❏ ❏ $_____ _________ Please provide details of a claim under any of the above mentioned schemes. ________________________________________________________ ________________________________________________________ Please supply and attach details of any relevant insurance cover (life or health) or superannuation benefit entitlements held and any payments received/to be received. By the applicant_______________________________________ ________________________________________________________ By the deceased_______________________________________ ____________________________________________________ Form 1 -- 7 of 13 -- S.R. No. 64/1997 Victims of Crime Assistance (Procedure) Rules 1997 7 DETERMINATION OF YOUR APPLICATION Would you prefer to: ❏ Attend a hearing at the Tribunal? ❏ Have your application determined in your absence? ❏ Have proceedings conducted in a closed Court? ❏ Have publication of your application restricted? Would you require an interpreter? Yes/No Language____________ 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. _________________________________ Applicant's signature ACCOMPANYING DOCUMENTARY EVIDENCE I attach the following documentary evidence in support of my claim (attach any documents e.g. medical certificates or statements of earnings) which support your claim): 1. (Description of document)––––––––––––––––––––––––––––––––– 2. –––––––––––––––––––––––––––––––––––––––––––––––––––––– 3.(etc.)––––––––––––––––––––––––––––––––––––––––––––––––––– STATUTORY DECLARATION Form 1 -- 8 of 13 -- S.R. No. 64/1997 Victims of Crime Assistance (Procedure) Rules 1997 8 I (name)_________________________________________________ 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––––––––this––––day of––––––––––––––––––19 . Name of witness__________________________________________ Title of witness___________________________________________ Address of witness________________________________________ __________________ Form 1 -- 9 of 13 -- S.R. No. 64/1997 Victims of Crime Assistance (Procedure) Rules 1997 9 Form 2 Rule 9 RELATED VICTIMS INFORMATION NOTICE (Victims of Crime Assistance (Procedure) Rules 1997) Section 30 Victims of Crime Assistance Act 1996 Tribunal Reference Number: To: You have lodged an application as a related victim of an act of violence. Section 11 of the Victims of Crime Assistance Act 1996 states that: A related victim of an act of violence is a person who, at the time of the occurrence of the act of violence— (a) was a close family member of; or (b) was a dependant of; or (c) had an intimate personal relationship with— a primary victim of that act who died as a direct result of that act. As a related victim you are required, within 21 days to NOTIFY the Tribunal of: (a) every other person you believe MAY BE a related victim of the act of violence; and (b) every other person you believe MAY ALLEGE that he or she is a related victim; and (c) any person you believe MAY APPLY because they have incurred funeral expenses as a result of the death of the primary victim. FAILURE TO COMPLY—If you fail to complete and return this form to the Tribunal by the date set out below: (1) Your application for assistance may be struck out. (2) You may be fined up to $5000 and you may be ordered to pay back some or all of any award of assistance given to you. * IMPORTANT : THIS FORM MUST BE COMPLETED AND RETURNED TO THE TRIBUNAL BY__________________. Form 2 -- 10 of 13 -- S.R. No. 64/1997 Victims of Crime Assistance (Procedure) Rules 1997 10 Please provide the name and address (or if not known as much as you do know) of any person whom you believe may fall into the category of a victim with respect to the death of: (name of deceased) (Name of potential victim):_______________________________________________________( Address of potential victim):_______________________________________________________ (Name of potential victim):_______________________________________________________ (Address of potential victim):_______________________________________________________ _______________________ (Signature of Applicant) __________________ Form 2 -- 11 of 13 -- S.R. No. 64/1997 Victims of Crime Assistance (Procedure) Rules 1997 11 Form 3 Rule 10 NOTICE TO PERSON WITH POSSIBLE RIGHT TO APPLY (Victims of Crime Assistance (Procedure) Rules 1997) Date: Dear Sir/Madam RE: DEATH OF ___________________________ It has come to the Tribunal's attention that you may be a related victim of the act of violence which led to the death of__________________. If so you may be entitled to apply for an award of assistance. Section 11 of the Victims of Crime Assistance Act 1996 states that: A related victim of an act of violence is a person who, at the time of the occurrence of the act of violence— (a) was a close family member of; or (b) was a dependant of; or (c) had an intimate personal relationship with— a primary victim of that act who died as a direct result of that act. If you believe you may be a related victim and wish to lodge a claim for assistance, please do so within 21 days. If you do not lodge the claim within 21 days, the Tribunal may not be able to assist you. An application form has been enclosed. If you are unsure about making an application or require further information you can contact the Tribunal on the above telephone number or seek the advice of a legal practitioner. Registrar Crimes Compensation Tribunal Form 3 -- 12 of 13 -- S.R. No. 64/1997 Victims of Crime Assistance (Procedure) Rules 1997 12 Dated: 30 June 1997 M. A. ADAMS QC, CM D. J. MULING, Deputy CM J. POPOVIC, Deputy CM ═══════════════ -- 13 of 13 --