Supplementary Compensation

To claim compensation for loss of earnings or earning capacity as a result of a criminal injury sustained in Northern Ireland on or after 1 May 2002, you should complete an application form.

You can download and print the form in PDF format. Once completed and signed you should forward it to the Compensation Agency at the following address:

The Compensation Agency Royston House
34 Upper Queen Street
Belfast BT1 6FD

Please read the Guidance notes to help you to complete the form.

Use this form only where the victim lost earnings or earning capacity for longer than 28 weeks as a direct consequence of the injury.

You must complete a separate form for each claimant.

For comprehensive information on the Criminal Injuries Compensation Scheme 2002 and your entitlements, see our list of guides.