Templates and forms for the Financial Assistance Scheme

Authorised representatives

Nominating an authorised representative

If your authorised representative is a lawyer

FAS Client authorisation form
Word 138.89 KB
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If you plan to have a lawyer be your authorised representative, they need to complete a client authorisation form below instead of a statutory declaration.

Learn more about lawyers' responsibilities when assisting with a FAS application.

If your authorised representative is not a lawyer

If your chosen authorised representative is not a lawyer, you will need to fill out a statutory declaration.

You will need to sign it in front of an authorised statutory declaration witness. For more information on who can witness statutory declarations, visit the Department of Justice and Community Safety's website.

A victim may complete this statutory declaration to nominate an authorised representative:

FAS statutory declaration template – Victim appointing an authorised representative
Word 120.5 KB
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A victim’s parent, guardian or administrator may complete this statutory declaration template to nominate an authorised representative:

FAS statutory declaration template - Parent/Guardian/Administrator appointing an authorised representative
Word 121 KB
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Other statutory declarations

For victims

Victims may complete this statutory declaration template to explain the reasons why they have not reported the incident(s) to the police.

Victims will also have the option of downloading a FAS generated statutory declaration which will include inputs based on the answers they provide in their application.

Victims may complete this statutory declaration template in relation to any issue on which they would like to provide evidence to the FAS to support their application.

FAS statutory declaration template for victims – Miscellaneous
Word 118.5 KB
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Examples of issues can be found on the nominate someone to help with your FAS application page.

For authorised representatives

Authorised representatives may complete this statutory declaration template to explain the reasons why the victim has not reported the incident(s) to the police. Authorised representatives will also have the option of downloading a FAS generated statutory declaration which will include inputs based on the answers they provide in their application.

FAS statutory declaration template for authorised representative - Police reporting
Word 123 KB
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This statutory declaration template may be completed by an authorised representative in relation to any issue on which you would like to provide evidence to the FAS to support your application:

FAS statutory declaration template for authorised representative – Miscellaneous
Word 119 KB
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Examples of issues can be found on the nominate someone to help with your FAS application page.

Templates for letters and reports from service providers

FAS Medical and/or mental health report template
Word 136.95 KB
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Must be used if the FAS has pre-authorised and requested the report.
FAS Support or social worker letter template
Word 84.53 KB
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Optional to use for supporting evidence.
FAS Medical letter template
Word 83.71 KB
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Optional to use for supporting evidence.
FAS Mental health letter template
Word 82.11 KB
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Optional to use for supporting evidence.

Learn more about the resources available for service providers.

Cultural support plans

Cultural support plans can provide the FAS with information about a person’s cultural connection and guide how the FAS engages with Aboriginal or Torres Strait Islander people when they apply to the FAS.

Cultural support plans can also provide information to support a victim’s application, such as how assistance for specific activities can nurture connections with culture, family and community and support recovery.

Aboriginal and Torres Strait Islander people applying to the FAS can provide an existing cultural support plan if they have one, or use one of the templates provided by the FAS below.

Adult - FAS Cultural support plan template
PDF 130.74 KB
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Child & Young person - FAS Cultural support plan template
PDF 90.98 KB
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Updated