Victim Notification Register (VNR)

Applicant details*

PrefixFirst NameLast Name
Date of birth*

DayMonthYear
If you are under 16 VNR will need to contact a parent/guardian or a caseworker (CPFS or counsellor) to confirm it is appropriate for you to register.
Name*
Relationship*
Contact number*
Please enter either a valid home, work or mobile phone number.Format: (00) 0000-0000.
Home address

Street Address

Street Address Line 2

SuburbState

Post codeCountry
Is your home address your postal address?*

NoYes
Postal address

Street Address/ GPO Box

Street Address Line 2

SuburbState

Post code
Mobile number
Please enter a valid phone number.Format: 0000-000-000.
Home Number
Please enter a valid phone number.Format: (000) 0000-0000.
Work Number
Please enter a valid phone number.Format: (000) 0000-0000.
Email
example@example.com

Eligibility for registration
From the options below, select the box that applies to your application.

As a direct victim of crimeFamily Violence Restraining OrderVictim of historical family violence (VNR will contact you to further discuss your application, as further information will be required)As an immediate family member of a deceased victim (if ticked please complete the details below)As the parent or guardian of a child victim (if ticked please complete the details below)
Name of the deceased victim
Date of birth of the deceased victim:

DayMonthYear
Date
Your relationship to the deceased victim
(eg. Victim’s mother, father, child, sibling etc)
Name of the child victim
Date of birth of the child

DayMonthYear
Date
Your relationship to the child
(eg. Child’s mother, father, grandmother, grandfather, guardian etc)

Details of offender and offence

Fill out as much information as you can – if unknown please leave it blank
Name of offender
AdultJuvenile
Name of offender
AdultJuvenile
Is the offender in custody

NoYes
Date of court appearance

DayMonthYear
Type of offence
Date of offence

DayMonthYear
Location of offence

Preferred mode of communications

The VNR will normally communicate with you in writing.
Select the appropriate box below for your preferred way of receiving the information from VNR.

Normal postal deliveryEmail
It is very important that you notify VNR of any changes to your contact details.
Would you like an officer to discuss this application with you?

NoYes
Are you from an Aboriginal or Torres Strait Islander cultural background?

NoYes
Do you require an interpreter?

NoYes
Please indicate the language required*

Alternative Contact Person

You have the option of nominating an alternative contact person in case VNR is not able to contact you. We suggest you consider nominating someone who is aware of your situation as a victim of crime and who is likely to know your whereabouts.
Name of alternative person

PrefixFirst NameLast Name
Date of birth

DayMonthYear
Date
Address

Street Address

Street Address Line 2

SuburbState

Post code
Mobile Phone Number
Please enter a valid phone number.Format: 0000-000-000.
Home Phone Number
Please enter a valid phone number.Format: (00) 0000-0000.
Work Phone number
Please enter a valid phone number.Format: (00) 0000-0000.
Email
example@example.com

Provision of contact details to Commissioner for Victims of Crime (CVOC)
Occasionally, the CVOC may request the contact details of victims of crime registered with VNR. Please indicate if you consent for this to happen should the CVOC wish to contact you directly.*

NoYes
Please verify that you are human*
Should be Empty:

Eligibility for registration