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Communities & Justice

Corrective Services NSW

CSNSW Victims Registration Form

The information you provide on this form will be used to assist Corrective Services NSW to provide you with relevant information and will be treated in the strictest of confidence.

To complete this form you will need:

Photo Identification; and
The name of the offender and details of the offence.

If you do not have photo identification or need help completing the form please contact us on 02 8688 0555.

The information you provide on this form will be used to assist Corrective Services NSW to provide you with relevant information and will be treated in the strictest of confidence. If you have any questions please contact us on 02 8688 0555.

If you have any questions please contact us on 02 8688 0555.

1 Your details

Title *

Date of birth *

Surname/family name *

Given names *

Have you been known by any other name?

Yes

No

Surname/family name *

Given names *

Postal Address *

State *

Suburb *

Postcode *

Preferred contact number *

Secondary contact number(optional)

Email *

I would prefer to receive letters by: *

Email

Post

The Victims Register will try to speak with you first to provide information. We will then send you written information. If you live internationally information will be provided by email.

The following section is optional and providing this information is voluntary. The information in this section will be used for statistical purposes. Knowing this information will also help us to meet your needs.

Do you require an interpreter (includes sign language interpreter)?

Yes

No

Please indicate language required *

Do you identify as: *

What ancestry do you identify with?(Please select all that apply. If using the web version of this form, press and hold ‘CTRL’ to select all that apply)

Other

Will you need help to understand the information we give you?

Yes

No

What help do you need?(Specify the disability so that we can tailor our support accordingly) *

2 Relationship to the victim

Please describe yourself: *

Direct victim

Family representative of a deceased victim or primary caregiver of an underage victim

Guardian of an adult victim who has a legal incapacity

How many victims are you representing? *

3 Details of offence

How many offenders do you want to register against? *

Name of offender *

Nature of offence *

Name of offender *

Nature of offence *

Name of offender *

Nature of offence *

Name of offender *

Nature of offence *

Name of offender *

Nature of offence *

Name of offender *

Nature of offence *

Name of offender *

Nature of offence *

Name of offender *

Nature of offence *

Name of offender *

Nature of offence *

Name of offender *

Nature of offence *

Other information that you may have that may help us verify your case:

Date of offence

Location of offence

Police Event Number

Court Case Number

Date of court appearance

Location of court

Investigating officer/station

4 Alternate contact

You can provide an alternate adult contact, who we may leave a message with if we cannot reach you. Detailed information will not be disclosed to this person.

Do you wish to provide an alternate contact? *

Yes

No

Given names

Surname/family name

Relationship to you

Contact number *

Email *

5Proof of identity

The CSNSW Victims Register will be unable to process your application if you do not provide identification. As the applicant you are required to provide evidence to prove your identity.

Applicant's identification

You need to upload one current photographic proof of identity for yourself.

File can be uploaded up to 10MB of size.

Allowed types: jpg, jpeg, png and pdf *

Driver's licence

Australian Proof of Age Card

Passport

Proof of Identity: *

6 Declaration

I understand that if my application is approved: *

My information will be recorded on the Victims Register for the duration of the offender’s sentence.
My personal information will be collected, used, and retained by Corrective Services NSW so I can be included on the Victims Register and will be disclosed to other government agencies to verify my details and eligibility and manage my registration.
After the sentence expires, my details will be maintained if the offence becomes eligible under the Crimes (High Risk Offenders) Act 2006 and the Terrorism (High Risk Offenders) Act 2017.
My registration is voluntary, and I can notify the Victims Register if I no longer wish to be registered.
Information from the Victims Register is confidential; I will not disclose it publicly without Corrective Services NSW’ approval, including on social media or with public messaging agencies.
If I am the primary caregiver of the direct victim, my registration continues when they turn 18. The direct victim can also register when they are old enough.
I cannot use the information for purposes other than those for which it was provided.
I understand that the type of information that Corrective Services NSW may provide me is restricted by law.

I consent to the collection, use, disclosure, and retention of my personal information so that I can be included on the victims register and supplied with information.*

I consent to my personal information being shared with other Victims Registers including the NSW Specialist Victims Register, the NSW Youth Justice Victims Register or Victims Registers in other Australian States or Territories, for the purpose of registration if required. *

I declare that my alternate contact consents for the Victim’s Register to contact them if they cannot reach me. *

I confirm that I have read and understood the information in this form and that all information I provided is true and correct. *

Your form has been successfully submitted. A copy of your responses will be sent to you by email.

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On 1 July 2019, the Department of Communities and Justice (DCJ) brought together the former departments of Family and Community Services (FACS) and Justice. While FACS no longer exists, our apology to the Stolen Generations stands. You can read our apology to the Stolen Generations here.

Informed by lessons of the past, DCJ is improving how we work with Aboriginal people and communities.

We listen and learn from the knowledge, strength and resilience of Stolen Generations Survivors, Aboriginal Elders and Aboriginal communities.