Criminal Injuries Compensation Authority (CICA) Application

Step 1 of 9
Who are you applying for? *
Are you 18 or over? *
What is the reason for your claim? *
Victim Details
Full Name *
Have you ever been known by another name? *
Date of Birth *
Gender *
Phone Number *
Email Address *
Address Line 1 *
Address Line 2
Town/City *
County *
Postcode *
National Insurance Number *
Claimant Details
Full Name *
Gender *
Relationship with Victim *
Phone Number *
Email Address *
Address Line 1 *
Address Line 2
Town/City *
County *
Postcode *
About the person who died
Full Name *
Enter their date of birth *
Enter their date of death *
Address Line 1 *
Address Line 2
Town/City *
County *
Postcode *
Incident Details
Were you a British citizen when the crime happened? *
Select the option that best describes you *
Description of the Incident *
Did the crime happen once or over a period of time? *
When did the crime happen? *
When did it start? *
When did it stop? *
Location of the Incident *
Do you know the offender's identity? *
Was the Crime Reported to Police Force? *
Provide investigating police force name *
Have you made any previous claims or received any other form of compensation or damages in connection with this incident? *
Injury Details
What led to your injuries?
This helps us to make a decision about your claim. It also helps us to make sure the information we get from other places, such as the police, is accurate. You can select more than one answer.
What injuries were sustained due to the physical assault? *
What injuries were sustained due to sexual assault or abuse? *
What injuries were sustained due to domestic or family violence? *
What injuries were sustained due to arson or fire-raising? *
What injuries were sustained due to a terrorist attack in Great Britain? *
What injuries were sustained due to an animal or vehicle? *
What injuries were sustained due to witnessing an incident? *
What psychological injuries were sustained? *
What dental injuries were sustained? *
What other injuries were sustained? *
Did you get any Infection? *
What treatment are you receiving for your physical injuries? *
How have your injuries affected your daily life and routine? *
Has this incident had any effect on your family or social life? *
Did you lose a pregnancy? *
Are you registered with a GP, and have you consulted a GP about your injuries? *
Are you currently receiving medical treatment, or have you received treatment in the past? *
Do you have a disabling mental injury *
Have You Seen a Dentist About Your Injuries? *
Loss of Earnings or Expenses
Employment Status at the Time of the Incident *
If you were not employed at the time of the incident, kindly provide the reason for your unemployment
Have you been unable to work or had a very limited capacity to work due to your injuries? *
Has this been for more than 28 weeks? *
This can be a single period of time or cover several periods of time since the crime.
Details of any lost earnings due to the injury *
Please attach proof of lost earnings or expenses *
Details of any out-of-pocket expenses *
Funeral Costs
Type of Application *
Is the claimant paying for any of the funeral costs *
Is anyone else contributing to the funeral costs? *
What is the total cost of the funeral? *
If you are not sure what the total cost is, enter an estimated amount in numbers only, such as 125.50
Have you previously applied for compensation related to this crime? *
Legal Information
Has the victim previously applied in connection with any other crime? *
Has the victim applied for or received any other form of compensation or damages in connection with this crime? *
Do You Currently Have Any Unspent Criminal Convictions? *
Witness Details (If Applicable)
Full Name
Phone Number
Email Address
Witness Statement
Supporting Documents

Attach Documents

Document Name *
Select Document *
Medical records/Police reports/Photographs of injuries/Any other relevant evidence
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Acknowledgment and Agreement
By submitting this form, I confirm that:

  1. The information provided is true, complete, and accurate to the best of my knowledge.

  2. I understand that providing false or misleading information may result in my claim being rejected or legal action being taken.

  3. I agree to the Terms and Conditions, Privacy Policy, and any other policies related to this application.

  4. I give consent to SFR Solicitors to process my personal and sensitive data for the purpose of evaluating my claim, in accordance with the applicable laws and regulations, including GDPR.

  5. Giving this information does not Guarantees you the compensation

Signature Field
Name *
Date *
Signature *