Personal Information

First Name *

Last Name *

Email Address *

Phone Number *

Crime Location

Did the crime occur in England, Scotland, or Wales? *

Yes No

Specify Crime Place

Citizenship Status

Are you a British Citizen? *

Yes No

Date of Incident

Date when the incident happened *

Incident Timeline

Did the incident happen within the last 2 years? *

Yes No

Previous CICA Applications

Have you applied before to CICA for the same incident? *

Yes No

Please confirm your consent below *

By submitting this form, you confirm that:

SFR Solicitors may review the information you have provided to assess whether your enquiry may be eligible for a potential Criminal Injuries Compensation Authority (CICA) claim.
You consent to SFR Solicitors requesting and obtaining relevant information from Streamlined Forensic Reporting Limited (SFR Medical) where reasonably necessary for this assessment.
Submission of this form does not instruct SFR Solicitors to act on your behalf and no claim will proceed unless you later provide separate express authority.
You may withdraw your consent at any time. Further details are available in our Privacy Policy.

I confirm that I have read and understood the above and consent to my information being used as described. No, I do not want to be contacted by a law firm.

For more information about our privacy policy, please visit our Privacy Policy.

Need help with claims or eligibility questions? Contact us at [email protected] or
+44 20 4615 4242

CICA Eligibility

Personal Information

Crime Location

Citizenship Status

Date of Incident

Incident Timeline

Previous CICA Applications

Please confirm your consent below *