Permission to Speak Form

The Virginia Victim Fund protects claimants’ information by verifying all callers. VVF staff will only discuss claims with third parties that are authorized by the claimant in this form.

Form Instructions: 

The claimant will provide the name, relationship, and last 4 of Social Security Number for anyone with whom they will permit VVF to discuss claim information. This form must be completed in its entirety or it is not valid.

Fax or mail to:
Virginia Victims Fund
P.O. Box 26927
Richmond, VA 23261
Fax: 804-823-6905