Victims Support and Rehabilitation Act 1996 s.50 or s.51(1)(a) or Victims Compensation Act 1987 s.47(2)(c) or (a)

APPLICATION TO PAY AMOUNT OF RESTITUTION BY ARRANGEMENT OR BY INSTALMENTS

Reference no: RTAccount no: D0

I, (Name of Defendant)

of Postcode: (Postal Address)

apply to pay restitution as follows:

A: PAYMENT AMOUNT (tick one of the following boxes)

1. [ ] The full amount shown on the provisional order.

Or 2. [ ] A total sum of: $ *

* Reason for less than full payment:

B: PAYMENT TYPE (tick one of the following boxes)

1. [ ] Lump Sum - Payment of the above amount by one lump sum payment *, on or before / / (date). Or:

2. [ ] Lump Sum and Monthly Instalment - Payment of the above amount by an initial lump sum payment * of $

on or before / / (date) and then monthly instalments of $ starting on / / (date). Or:

3. [ ] Monthly Instalment - Payment of the above amount by monthly instalments of $ starting on / / (date).

(* Please note that payment of the lump sum must be made by cheque or money order.)

C: PAYMENT METHOD (tick one of the following boxes)

1. [ ] CENTREPAYI wish to pay my restitution instalments using Centrelink’s Centrepay facility and will take the attached Form 3 to any Centrelink office and complete an application form “Centrepay Deductions” (Centrelink form number SA325.0203).

OR

2. [ ]DIRECT DEBIT I wish to pay my restitution instalments using the direct debit facility:

Direct Debit Request

I/We request, until notified in writing, that monies due to Victims Services and/or the Victims Compensation Tribunal be drawn under the Direct Debit System (User ID 231870) from my/our account, as per the details listed below:

Name of Financial Institution:

Branch address: Type of Account#:

Accounts details are:

BSB:II - I IAccount No: I I I I I I I I

Account Name:

I/We acknowledge that this Direct Debit arrangement is governed by the terms of the Direct Debit Service Agreement received from you.

Authorised Signature(s)*

Date: / / Date: //

Note: Direct Debit instalments will be debited on the 15th day of each month. #Direct Debit may not be available from all accounts. Please check with your Financial Institution. *Requires the same signature(s) that is (are) authorised to operate on the account. (Please provide a copy of an encoded deposit slip or cheque with this application.)

3. [ ]DIRECT PAYMENT I wish to pay my restitution instalments by directly crediting the account of the NSW Attorney

General’s Department. Please send me a deposit book.

4. [ ] OTHER ARRANGEMENTS I propose to make my instalment payments by sending a cheque or money order by mail to

Financial Services Branch, Attorney General’s Department GPO Box 6 Sydney 2001. Or: by arranging for my financial

institution to make the monthly payment on my behalf.

If this application is accepted, I undertake to make payments in accordance with the Restitution Order or Arrangement.

Date: / / .

IMPORTANT INFORMATION ABOUT ARRANGEMENTS TO PAY RESTITUTION

Payment Amount (Part A)

You may apply to pay an amount of restitution by arrangement for either the amount shown on the provisional order (which was the amount paid to the victim under the award of compensation), or a reduced amount. If you apply to pay a reduced amount, you must state your reasons for doing so. E.g. More than one defendant was convicted, my age at the time of the offence and/or my level of culpability (fault), etc.

Payment Type (Part B)

You may chose to pay the amount you have nominated by lump sum (one payment) by a specific date or by monthly instalments starting on a specific date. You may also make payment by a combination of lump sum and monthly instalments.

Payment Method (Part C)

You may choose to make your monthly instalment payments by one of several methods. There are advantages to making payment by CentrepayDeduction or Direct Debit, these advantages include; saving the cost of a money order or cheque, an envelope and postage; not having to go to a post office or bank; not having to remember to pay your instalment each time it is due; no other costs or charges. You also avoid the possibility of a default in payment and any resultant enforcement action, including any additional interest or legal costs. Of course you may also make payment by mail or by having your financial institution make your payment for you but you must bear the associated costs.

This application must be supported by:

  • A properly completed Affidavit of Financial Circumstances together with relevant supporting financial information.
  • A completed Notice of Objection to a Provisional Order for Restitution (or Notice of Intention to Show Cause);
  • Any other relevant documentary evidence (e.g. court, police or other documents, medical certificates, financial records, etc.) that you believe is relevant to the matter.

The amount to be paid by arrangement will be determined by the Director/Registrar having regard to:

  • Your financial circumstances.
  • An assessment of your culpability in relation to the act of violence on which the award was based. And,
  • any other relevant matters.

If an arrangement is not agreed with the Director, the matter will be listed for determination at a hearing before the Tribunal

Arrangements do not incur further costs or interest if you comply with the terms of the arrangement. If you do not comply with the terms of the arrangement, the Director may seek confirmation of the provisional order at a hearing before the Tribunal and commence enforcement action.

Changed financial or other circumstances

If your financial or other circumstances change and you are unable to comply with the terms of the arrangement, you must notify the Director immediately in writing. The Director will review the arrangement and may accept suitable alternative arrangements.

Legal Advice

If you wish to seek legal advice as to your liability to pay the amount provisionally ordered, you should contact a legal practitioner or the Chamber Magistrate at any Local Court. You may also contact LawAccess on 1800 888 529. However Victims Services will not meet the cost of legal advice or representation.

Questions

Any inquiries concerning this application or restitution proceedings generally may be directed to the Restitution Section of Victims Services:

By Telephoning: (02) 9374 3111 or 1800 069 054 (Toll Free)

Or by writing to: The Director, Victims Services Locked Bag A5010 SYDNEY SOUTH NSW 1235

Email and Websites

Email: Websites: Victims Services or LawAccess

Version = September 2004

VICTIMS SERVICES

ABN 64 782 244 502

CENTRELINK – CENTREPAY DEDUCTION FORM

THE FOLLOWING INFORMATION IS PROVIDED TO HELP YOU COMPLETE THE APPLICATION FORM “CENTREPAY DEDUCTIONS” (CENTRELINK FORM NUMBER SA325.0206), WHICH YOU CAN OBTAIN FROM ANY CENTRELINK OFFICE.

Section B / Organisation details
3. Name, address and phone number of the organisation to be paid / Attorney General’s Department
PO Box 6
Sydney NSW 2001 Telephone: (02) 9374 3111
4. Organisation’s Centrepay Reference Number (CRN) / 555 053 508S
5. Your own account number with the organisation /
D0
Your Debtor Account Reference Number
6. Type of bill / Court Fine
7. Type of request / New
Section C
9. Amount to be deducted from your Centrelink payment? / You will need to halve the instalment amount that you are required to make each month to meet the terms of your order or arrangement:
e.g. $50 per month = $25 per fortnight
$40 per month = $20 per fortnight
10. Date deductions to start from / For existing defendants, this should be your next Centrelink payment date. For new defendants, you should use the commencement date in your order or arrangement.
Section D

11. Target amount

/ For existing defendants, this will be the balance of your debt at the date of the application. For new defendants, this will be the total amount ordered or arranged to be paid.

PLEASE REMEMBER

IF YOU BECOME INELIGIBLE TO RECEIVE A PAYMENT FROM CENTRELINK OR YOU DECIDE TO CHANGE YOUR CENTREPAY DEDUCTION, YOU MUST NOTIFY VICTIMS SERVICES OF THE CHANGE AND MAKE ARRANGEMENTS FOR AN ALTERNATIVE METHOD OF PAYMENT. IF YOU DEFAULT ON PAYMENT OF AN INSTALMENT, YOU MAY BE LIABLE FOR ENFORCEMENT ACTION UNDER THE LOCAL COURT (CIVIL CLAIMS) ACT 1970, WHICH MAY RESULT IN THE SEIZURE OF SUCH OF YOUR ASSETS AS ARE REQUIRED TO MEET YOUR RESTITUTION LIABILITY AND ADDITIONAL INTEREST AND/OR COSTS INCURRED.