I-6, r. 1 - Regulation respecting the application and notice of election to claim benefits by a crime victim

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1. The application of a presumed victim of a criminal offence, to benefit from the provisions of the Crime Victims Compensation Act (chapter I-6) must give, in support of the claim:
(a)  the name and address of the victim or of the claimant and that person’s social insurance number;
(b)  the date, the hour, the place of the crime and the description of the attendant circumstances;
(c)  the name and address of the witnesses;
(d)  the name of the hospital centre where the victim was admitted and treated, as well as the name and address of the attending physician;
(e)  the nature of the injuries;
(f)  in case of death, the date, the name and address of the dependents and their degree of relation to the victim;
(g)  the name of the police force that carried out the investigation, if known by the victim or the claimant.
R.R.Q., 1981, c. I-6, r. 1, s. 1.