Apply for financial assistance—primary/related victim, part A

Use this form to apply for financial assistance from Victim Assist Queensland if you are a primary or related victim of violence committed in Queensland. Return to the information page if you need more information.

It is an offence under the Victims of Crime Assistance Act 2009 to give false or misleading answers to the questions in this form or to provide a supporting document that is false or misleading.

Financial Assistance Application Form: Primary and Related victims

Victims of Crime Assistance Act 2009 (Sections 51 and 52)

Form 13A, Version 1, effective 14 September 2023