S.L. 9.12 Art. 22Saving. L.N. 190 of 2007.

Any claim pending under the the Criminal Injuries

Compensation Regulations, 2007, which are hereby revoked, shall continue to be heard and treated under these regulations, and the provisions of these regulations shall, apply in mutatis mutandis, respect of such pending claim. SCHEDULE

* APPLICATION FOR CRIMINAL INJURIES COMPENSATION

surname

Fixed line Mobile applicant as a qualifying claimant: surname of deceased victim death _____/____________/_______ degree of dependency on the be submitted commission of crime _____/____________/_______

commission of crime description of nature and consequences of crime assailant where known to inform the police, or other body or person of the circumstances giving rise

Co-operation with the police or other authority in attempting to bring the assailant to

G. If assailant has been brought to justice, state when and before which Criminal

H. Has the Criminal Court already established the compensation due to the crime? If so, state the date of the order.

I. Has any legal action to claim compensation been taken? If so, state what and, if proceedings have been terminated, the final outcome thereof:

J. Give a sufficient description of the nature (physical, psychological, proprietary, damage etc.) and extent (e.g. partial or permanent disability, medical and expenses, loss or reduction of earnings resulting from temporary or permanent work) of the criminal injuries suffered, indicating the pecuniary amount hereby claimed:

Part III Certificates and documents to be attached hereto