Application for Financial Assistance for Canadians Victimized Abroad

Our Commitment to Privacy

Applicant (required)
Personal and Payment Information

Do you have travel insurance? (required)
Do you have work insurance? (required)

Nature of Victimization
Victimization Type (required)
Have you contacted the Canadian Embassy or Consulate to report the crime? (required)
Do you have a police report (required)
If yes, send the report by email to:


By submitting this application, (the applicant) authorizes the Department of Justice Canada to disclose any information received in this application within the Department and the Government of Canada or to outside entities for the following purposes: to reach a decision on this application, to administer and monitor the implementation of the project or programming, or to evaluate the results of the project or programming after project completion. This disclosure of any information received in this application may also be used to reach a decision on any other application of the applicant for funding under any other departmental program.

In the event of an access to information request regarding the present funding application or any relevant information about the organization in the Department's possession, the information provided to the Department will be entirely disclosed, with the exception of personal information, which will be treated in accordance with the Privacy Act.

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