1
Send your application to us via email at victims.regis[email protected]w.gov.au or post to
CSNSW Victims Register, Locked Bag 5111, Parramatta NSW 2124
CSNSW Victims Register
Application Form
Information for victims of crime
The Corrective Services NSW (CSNSW) Victims Register is a service that provides important
information to registered victims about an oender.
We understand that receiving this information may be a dicult or confusing time for you. Our aim
is to provide you with a responsive and supportive service.
You can contact the Victims Register Monday to Friday between 9am to 5pm. We are closed on
public holidays. We welcome you to call us to ask questions or discuss any concerns.
Phone: (02) 8688 0555
Email: victims.regis[email protected]w.gov.au
Please call us if you would like help in your preferred language. We will organise a free interpreter
for you.
What is a Registered Victim?
A registered victim is someone registered
with CSNSW Victims Register to receive
information about an oender that
committed an oence against them.
Who can register?
To access the Victims Register you
must be:
• the victim of an oence; or
• a family representative of a victim who died
from the crime; or
• the victim’s primary caregiver, if the victim
is currently under 18 years or has a legal
incapacity.
The oender must be:
• serving a custodial sentence for an oence
that relates to you, and
• under the supervision of CSNSW, even if:
o you are in another State/Territory;
o the oence happened in another State/
Territory;
o the oender was sentenced under
Commonwealth law or in another State or
Territory in Australia;
o the oender has already been in custody
for a long time;
o the oender is on parole.
If you do not meet the eligibility
criteria:
• we can still consider your application if
your personal safety is at risk. For example,
if you can demonstrate a history of
violence, stalking, or threats towards you
from the oender.
2
Send your application to us via email at victims.regis[email protected]w.gov.au or post to
CSNSW Victims Register, Locked Bag 5111, Parramatta NSW 2124
What information can we tell
you?
Registered victims can be told:
• The oender’s:
o sentence details,
o location in custody,
o security classification,
o eligibility for unescorted leave,
• If the oender dies while serving a sentence,
• If they escape from custody,
• When they will be released from custody,
• If there are any change to the earliest
possible release date,
• If the oender will be considered for parole,
• If parole is revoked.
What we cannot tell you
There is information we cannot tell you,
including:
• New charges or sentences not related to you.
• The oender’s medical and psychological
history, including the cause of death if the
oender dies in custody.
• Transfers between Correctional Centres or to
a medical facility.
• The oender’s location once they are
released from custody.
• The oender’s immigration status.
How do I apply to be on the
Victims Register?
Complete and sign the application form
attached. Then send it to the Victims
Register with a copy of your photo
identification and any other supporting
documents.
You can send the form and supporting
documents via email or post:
Email: victims.regis[email protected]w.gov.au
Post: CSNSW Victims Register
Locked Bag 5111
Parramatta NSW 2124
Multiple oenders
If you wish to be registered against multiple
oenders in relation to dierent oences;
please submit separate applications for each
oender.
What happens after I submit
my application?
After we receive your application, we will
process it within ten business days. Your
application may be delayed if you have not
provided all the information we need in the
application form.
We may contact other agencies to verify your
information or request further information
from you.
We will let you know the outcome of your
application. If you are registered, we will give
you information about the oender.
If you are ineligible, we will let you know and
provide details of other services that may help
you.
How long will my registration
remain active?
Your registration will remain active until the
oender has served the full sentence that
relates to you. This includes any part of the
sentence that the oender spends on parole.
After this your registration will be closed and
we will no longer be able to provide you with
information or updates.
Your registration will also be closed if:
• You request in writing for your registration
to be closed.
• The oender dies.
• The oender is transferred to a dierent
State/Territory or overseas.
• The oender’s conviction against you is
overturned.
• The oender transfers to another Government
agency such as an immigration detention or
mental health facility.
• You disclose information given to you by the
Victims Register to anyone else.
3
Send your application to us via email at victims.regis[email protected]w.gov.au or post to
CSNSW Victims Register, Locked Bag 5111, Parramatta NSW 2124
Application to register with the
Corrective Services NSW Victims
R
egister
Section 279 Crimes (Administration of Sentences) Act 1999 NSW
The inf
ormation you provide in this form will be treated confidentially. The Victims Register
use the information to confirm your eligibility for the CSNSW Victims Register.
Please send your completed form and supporting documents to us by post or email.
Email: victims.regis[email protected]w.gov.au
Post: Victims Register
Corrective Services NSW
Locked Bag 5111
Parramatta NSW 2124
Phone us on 02 8688 0555 if you would like help to complete this form.
Please read carefully before signing and sending us this form. You may also like to keep a
copy for your records.
Section 1: Eligibility criteria
The CSNSW Victims Register can only register you if the oender is serving a custodial
sentence in NSW.
An oender is ‘serving a custodial sentence’ if they have been found guilty and given
a period of time that they will be in custody with Corrective Services NSW because of
their crime.
Please complete the details in the sections relevant to you.
Is the oender subject to one of the
following?
• Sentenced and in custody (prison)
• On an Intensive Correction Order due to a
personal violence oence
• On parole
• On a Supervision or Detention Order
issued by the Supreme Court
n
Yes
n
Unsure
n
No: You are not eligible to be on
the Victims Register
(If the oender is unsentenced, please
wait until after the sentencing hearing to
submit your application).
Are you over 18
years old?
n
Yes
n
No (a primary caregiver such as your parent or legal guardian
needs to register on your behalf. You can register yourself once
you turn 18).
4
Send your application to us via email at victims.regis[email protected]w.gov.au or post to
CSNSW Victims Register, Locked Bag 5111, Parramatta NSW 2124
Category A: Direct victim
Are you the direct victim of a crime committed by the
oender for which the oender has received a sentence?
n
Yes: Go to Section 2
n
No: Go to Category B
Category B: Primary caregiver or family representative
Are you the primary caregiver or family representative of
the victim?
n
Yes
n
No: Go to Category C
Are you the primary caregiver of a direct victim who is
under 18 years old or an adult who has a legal incapacity?
n
Yes: Victim is under 18
n
Yes: Victim has a legal
incapacity
n
No
Are you a family representative of a deceased victim of
an act committed by the oender?
If more than one family representative wants to register, each
person needs to complete their own application.
n
Yes
n
No
Direct victim’s details
Full name:
Date of birth: dd/mm/yyyy
What is your relationship to the direct victim?
E.g. victim’s next of kin, spouse/partner, parent or guardian,
guardian under a care order or a guardianship order,
grandparent, sibling, child.
Please attach supporting documentation in Section 6, showing
your relationship to the victim e.g. Marriage Certificate, Birth
Certificate, Medicare Card, Guardianship Orders, Care Order.
--- Go to section 2 ---
Category C: Other applicant with demonstrated safety concerns related to the
oender
Complete this section if you answered ‘No’ in Category B.
Can you demonstrate that your physical safety may be in
danger because of a history of personal violence against
you by the oender?
Attach a copy of a current or expired AVO/ADVO or police
report in Section 6
n
Yes
n
No
5
Send your application to us via email at victims.regis[email protected]w.gov.au or post to
CSNSW Victims Register, Locked Bag 5111, Parramatta NSW 2124
Category C: Other applicant with demonstrated safety concerns related to the
oender
Complete this section if you answered ‘No’ in Category B.
Can you demonstrate that your physical safety may be
in danger because of a connection between you and the
oender that led to the oender’s incarceration?
Attach a copy of documentation in Section 6 showing that you
were a witness in a court proceeding leading to the oender’s
incarceration
n
Yes
n
No
Can you demonstrate that your physical safety may be in
danger because of ongoing threats made to you by the
oender?
Attach a copy of ongoing threats in Section 6.
n
Yes
n
No
Section 2: Applicant’s details
(details of the person wishing to be registered)
Title:
n
Mr
n
Ms
n
Miss
n
Mrs
n
Mx
n
Dr
n
Other:_________________
Given name/s:
Surname:
Previous surname:
Date of birth:
Email address:
Mobile number:
Other phone
number:
Residential
Address:
Postal address
(if dierent
to residential
address):
6
Send your application to us via email at victims.regis[email protected]w.gov.au or post to
CSNSW Victims Register, Locked Bag 5111, Parramatta NSW 2124
Section 2: Applicant’s details
(details of the person wishing to be registered)
Contact
preference:
n
Phone
n
Email
n
Post
n
Online video call
Important:
We will always send information to your email address. If you don’t have an email
address, we will send the information by post.
How did you
hear about
the Victims
Register?
n
Corrective Services NSW
n
DPP/Witness Assistance Service
n
Victims Services NSW
n
Victim support/Advocacy service
n
Friend
n
Counsellor
n
Police
n
Other Government Agency
n
Other: _______________________________________________
This 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.
Gender:
Do you identify as:
n
Aboriginal
n
Torres Strait Islander
n
Aboriginal and Torres Strait Islander
n
Neither
n
Prefer not to specify
Do you need an
interpreter?
n
No
n
Yes Language required:_______________________________
Do you identify
as a person with
a disability?
n
No
n
Yes Nature of disability:_______________________________
Would you like
any reasonable
adjustments
made?
(For example,
getting letters in
large print.)
n
Yes Adjustments required:
_______________________________________________
n
No
7
Send your application to us via email at victims.regis[email protected]w.gov.au or post to
CSNSW Victims Register, Locked Bag 5111, Parramatta NSW 2124
Section 3: Details about the oence and the oender
• Oenders must be sentenced and under the supervision of CSNSW for us to register you.
• To assess whether your application may be eligible, complete Section 3.
• Please provide as much of following information as you can. It is ok if you do not
have all of this information.
Oender’s given name/s:
Oender’s surname:
Type of oence:
Date of oence:
Date of Court appearance:
Investigating police ocer/station:
Names of other oenders:
Section 4: Alternate contact’s details
We may need to leave a message with your alternate contact if we cannot reach you.
We will let the alternate contact know that we tried to call you. We will never tell them
details about your registration or information about the oender.
Alternate contact’s name:
Phone number:
Email address:
Alternate contact’s relationship
to you (for example are they
your parent, partner, friend etc)
By providing the details of an alternate contact you declare that that the alternate contact has
consented for their details to be provided to the Victims Register for this purpose.
8
Send your application to us via email at victims.regis[email protected]w.gov.au or post to
CSNSW Victims Register, Locked Bag 5111, Parramatta NSW 2124
Section 5: Applicant’s declaration
You must sign this declaration and provide identification documentation so that we
can process your application.
Please tick every box to declare your acceptance of these conditions.
n
I understand that if my application is approved, my information will be recorded
on the CSNSW Victims Register.
n
I have read and understand the information in this form.
n
I give permission for Corrective Services NSW to disclose my personal information
to other Government agencies for the purpose of verifying my details and
eligibility to register.
n
I understand that my details will be recorded on the CSNSW Victims Register for
the duration of the oender’s sentence relating to me. If I am registered against
an oender where the oence is eligible for proceedings under the Crimes (High
Risk Oender) Act 2006 and Terrorism (High Risk Oender) Act 2017, my details
will be maintained after the oender’s sentence has been served.
n
I understand that I can notify the Register if I no longer wish to be registered.
n
I certify that all information that I have provided is true and correct.
n
I understand and accept that the information supplied to me through the Victims
Register is confidential.
n
I will not release or disclose this information to any third parties or for the
purpose of public dissemination without approval from Corrective Services NSW.
n
I will not use any information supplied to me through the Victims Register for any
purposes other than those for which it has been supplied to me.
n
I will not use any information supplied to me for any purpose which would cause
harm or detriment to any person or agency.
n
I understand that legislation restricts the type of information that may be
provided.
n
I understand that I am providing my personal information voluntarily, and will
keep my contact details current so that the Victims Register can always contact
me. I understand if I do not keep my contact details up to date, then the Victims
Register may be unable to contact me to provide me a service.
n
By providing the details of an alternate contact I declare that that the alternate
contact has consented for their details to be provided to the Victims Register for
this purpose.
n
If I am applying as a primary caregiver of a direct victim, I understand that my
registration may remain with the Victims Register when a direct victim turns 18. I
understand that the child will also be able to register.
Signature of
applicant:
Date:
9
Send your application to us via email at victims.regis[email protected]w.gov.au or post to
CSNSW Victims Register, Locked Bag 5111, Parramatta NSW 2124
Section 6: Proof of ID and other supporting documentation
Information about an oender’s status is highly confidential. Your application must be
accompanied by proof of identity and, if applicable, the supporting documentation requested.
Please do not send original documents. Copies do not need to be certified by a Justice of the
Peace. We may contact you for more information.
All categories: Applicant’s proof of identity
You need to provide current photographic proof of identity for yourself. Please tick which one
you have attached
(only one is required).
n
Driver’s licence
n
Australian Proof of Age Card
n
Passport
Category B: Primary caregiver or family representative (if applicable)
If you answered ‘yes’ in Category B, you need to also provide supporting documentation as
proof that you are the legal guardian or family representative of the victim.
Family representatives and primary caregivers of children: Please tick which documentation
you have attached. You only need to attach one.
n
Birth certificate
n
Marriage certificate
n
Guardianship order
n
Power of attorney
n
Medicare card
n
Care order
Primary caregivers of an adult victim must also provide supporting documentation of the victim’s
legal incapacity. Please tick which documentation you have attached. You only need to attach one.
n
Guardianship order that shows their legal function on behalf of the victim
n
Letter from a relevant medical practitioner stating that the victim has a legal
incapacity and requires a primary caregiver
Category C: Applicant with demonstrated safety concerns related to the
oender
(if applicable)
If you answered ‘yes’ to any question in Category C, please select which documentation you have
attached. The more documentation you provide, the easier it will be for us to process your application.
n
Apprehended Violence Order (current or expired)
n
Apprehended Domestic Violence Order (current or expired)
n
Evidence of applicant being witness in court proceedings related to the oence
n
Proof of ongoing threats by the oender to the applicant
n
Other supporting documentation (specify below)
If other, specify details about your connection with the oender and how the supporting documentation
demonstrates your safety concerns.
10
Send your application to us via email at victims.regis[email protected]w.gov.au or post to
CSNSW Victims Register, Locked Bag 5111, Parramatta NSW 2124
Section 7: Application checklist
For your application to be considered, make sure you have completed the sections,
provided supporting evidence and signed the declaration relevant to you.
Below is a checklist for the various types of applicants.
Category A: Direct Victim (if applicable)
Use this check list if you answered ‘yes’ in Category A
n
Have you answered the questions in the application form?
n
Have you reviewed and signed the applicant’s declaration?
n
Have you attached a copy of proof of identity for yourself?
Category B: Primary caregiver or family representative (if applicable)
Use this check list if you answered ‘yes’ in Category B
n
Have you answered the questions in the application form?
n
Have you attached a copy of proof of identity for yourself?
n
Have you attached supporting documentation as evidence of your relationship to
the victim?
n
Have you attached supporting documentation as evidence that the adult victim
has a legal incapacity? (if applicable)
n
Have you reviewed and signed the applicant’s declaration?
Ca
tegory C: Applicant with demonstrated safety concerns related to the
oender
(if applicable)
Use this check list if you answered ‘yes’ to any question in Category C
n
Have you answered the questions in the application form?
n
Have you attached a copy of proof of identity for yourself?
n
Have you attached documentation to demonstrate all relevant safety concerns?
n
Have you reviewed and signed the applicant’s declaration?
T
his application form is provided in accordance with Section 279 of the Crimes
(Administration of Sentences) Act 1999 NSW.
The Victims Register will treat your information confidentially. The Victims Register will not let
oenders know that you are registered against them.  
11
Send your application to us via email at victims.regis[email protected]w.gov.au or post to
CSNSW Victims Register, Locked Bag 5111, Parramatta NSW 2124
Your personal information
This section provides information about
how Corrective Services NSW will deal with
your personal information, and how it will
be managed while you are registered.
Corrective Services is part of the
Department of Communities and Justice.
For information on how the Department of
Communities and Justice manages personal
information, please see the Department’s
Privacy Policy at https://www.justice.nsw.
gov.au/Pages/privacy.aspx
Use of personal information
The provision of personal information for
the purposes of the Corrective Services
NSW Victims Register is entirely voluntary
on the part of the applicant.
Your personal information will be used for
the purpose of administering all aspects of
the Victims Register, including determining
your eligibility to register.
Collection and disclosure - will my
personal information be disclosed
to third parties?
Your information is recorded on the CSNSW
Victims Register.
At the time of application, your personal
information may be disclosed to the
NSW Police Force, Department of Public
Prosecutions, or other Government agencies
for the purpose of verifying your details or
eligibility to be on the Victims Register. The
Victims Register may also need to request
supporting documentation from these
agencies as a part of the assessment process
to determine your eligibility.
Corrective Services NSW Victims Register
employees will have access to your
information. In some circumstances, your
information may be given to the NSW State
Parole Authority or the Serious Oenders
Review Council so that they may fulfil their
obligations towards you as a victim.
Your right to access information
Under section 9(1) of the Government
Information (Public Access) Act 2009
(GIPA Act), you have the right to make
an application to access information held
by public agencies, including Corrective
Services NSW. You will be provided
with this information, unless there is an
overriding public interest against disclosure
of the information. Under section 8 of the
GIPA Act, you may also make an informal
request for the release of information held
by Corrective Services NSW.
You also have the right to access your
personal information held by Corrective
Services NSW pursuant to section 14 of the
Privacy and Personal Information Protection
Act 1998 (PPIP Act).Under section 15 of the
PPIP Act you have the right to request the
amendment of personal information about
you that is held by Corrective Services NSW.
Other people’s right to access
information
Under Section 9(1) of the GIPA Act,
anyone, including the oender, can apply
to access information held by Corrective
Services NSW. However, the GIPA Act
allows Corrective Services to deny access
to information in the Victims Register so
that we can protect you and the personal
information you gave us.