VVF Claim Form

Form Description

Updated July 1, 2019
The Claim Form serves as the application to the Virginia Victims Fund. Victims indicate their interest in receiving benefits from VVF by providing this form to our office.

Form Instructions

It is important to be as thorough as possible while filling out the Claim Form. All relevant sections must be completed. Incomplete Claim Forms will be returned to sender. At minimum Sections A, B, C, D, G, H, and the Notarized Agreement must be finished. This form is invalid without a notary’s signature.

This claim should be filed within one year of the incident. If more than a year has passed, please include a letter explaining the delay with the Claim Form.

If a victim is 18 years or older, and they are not incapacitated, they must sign their own Claim Form, even if they were a minor at the time of the crime.

If a victim is a minor or an incapacitated adult, a guardian must serve as the victim’s claimant in Section B. If this is not the parent, prove paperwork to prove guardianship.

Anyone who incurred expenses on behalf of a victim’s funeral may provide a Claim Form to our office for reimbursement. Please include the deceased’s information in Section A.

Hospitals, physicians, and other medical providers cannot complete Claim Forms on behalf of their patients.

Please include any bills, receipts, invoices, and insurance documentation available with the Claim Form.

See the Notarized Authorization Guide for instructions on completing page 9 of the Claim Form. Click here for Instruction on completing page 9 in Spanish.

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