Survivors' Compensation Advocacy Project

Get legal SUpport

Application Form - Survivor Compensation
Modern Slavery / Labour Exploitation / Trafficking

Application Form - Survivor Compensation

Modern Slavery / Labour Exploitation / Trafficking

How can we help you ?

Feel free to contact us with your any questions, contact your team and lets schedule a call with us.

Before completing this form please review the following, by clicking on the following:

SECTION 1 - Survivor's Personal Details & Case Information

Survivor's Personal Details & Case Information

First Name

Surname

Date of Birth

Phone Number

Preferred Method of Communication

Are you able to communicate in English?

Have you been referred into the National Referral Mechanism (NRM)?

If yes to the question above, have you received a 'Reasonable Grounds' decision?

If yes to the question above, have your received a final outcome from the following options?

Are you currently being assisted by support service or charitable organisation?

Have you been affected by any of the following situations in the United Kingdom?

If known, Please enter approximate dates you experienced the above situation in:

Have you been affected by any of the following situations outside the United Kingdom?

If known, Please enter approximate dates you experienced the above situation in:

Have you experienced any of the following in the United Kingdom?

If known, Please enter approximate dates you experienced the above situation in:

Have you experienced any of the following outside the United Kingdom?

If known, Please enter approximate dates you experienced the above situation in:

Did you suffer any physical or mental injuries because of the experience or experiences you have suffered?

If you are able to, kindly share a brief summary of the situation you have suffered:

If you are able to, kindly share any other information that you may want us to know. For example: visa status, health problems, language issues:

SECTION 2 - Referring Organisations (If Applicable)

Please only complete the following questions if this form is being filled out on behalf of a Survivor,

Otherwise please skip to Section 3 'Data & Consent'

Is an organisation or support worker filling out this form on behalf of a survivor?

If yes to the question above, what is your full name:

Please enter your email

Please enter your Phone Number (If Applicable)

Please enter preferred Method of communication

Do you have the informed and express consent to receive communication on behalf of the survivor in relation to this application for legal support?

If yes to the question above, would you like us to correspond with you as the main point of contact (on behalf of the survivor)?

Would you like us to correspond with the survivor as well, or copy them in to the correspondence?

If you are able to, kindly share any other information that you may want us to know about the support being provided to the Survivor,

about the Survivor, or about any other relevant details:

SECTION 3 - Data & Consent

Consent to Process Information in this form - For everyone to complete:

Has the survivor given informed consent for the Survivors' Compensation Advocacy Project to process, store, and

use their personal data, and all the information contained within this form, for the purpose of providing support with a CICA application,

in accordance with GDPR and data protection law?

Has the Survivor Confirmed that he seeks support to pursue a claim for Criminal Injurises Compensation or Civil/Employment Compensation?

Has the Survivor Confirmed that he wishes to seek such assistance from the Survivors' Compensation Advocacy Project?

Has the Survivor confirmed that he understands that the Survivors' Compensation Advocacy Project is not a regulated legal service/advice

provider, and that it is an organisation made up of volunteers?

Has the Survivor confirmed that he understands that it at the ultimate discretion of the Survivors ’ Compensation Advocacy Project,

as to whether the casework support is able to be provided?

If you have any questions about this Privacy Policy, please contact us at: referrals@survivorscompensationadvocacy.org

How can we help you ?

Feel free to contact us with your any questions, contact your team and lets schedule a call with us.

Email us at:

referrals@survivorscompensationadvocacy.org

Application Form - Survivor Compensation Modern Slavery / Labour Exploitation / Trafficking

Application Form - Survivor Compensation Modern Slavery / Labour Exploitation / Trafficking

Application Form - Survivor Compensation Modern Slavery / Labour Exploitation / Trafficking

How can we help you ?

How can we help you ?

How can we help you ?

How can we help you ?

Application Form - Survivor Compensation
Modern Slavery / Labour Exploitation / Trafficking

Application Form - Survivor Compensation
Modern Slavery / Labour Exploitation / Trafficking

Application Form - Survivor Compensation

Modern Slavery / Labour Exploitation / Trafficking