How to submit an application for qualification to IVAC

You must allow about 20 to 30 minutes to complete the application. The time needed varies depending on your personal situation.

Depending on the situation, you may have to provide the following information  :

• Your full address and a telephone number to reach you
• Your health insurance number (HIN) (if you do not have a HIN, indicate this)
• Your social insurance number (SIN) (if you do not have a SIN number, indicate this)
• The type of relationship with the victim or rescuer, where applicable
• A description of the event
• The place where the event took place
• The date and time of the event. If you do not have the date and time of the event, you can indicate the period, month or year when the event took place
• The impact the event had on you
• Your emergency assistance needs
• Recourses you have initiated as a result of the event

Depending on the situation, you may have to provide the following information:

• The full name of the person you are applying for and their contact information  
• Their health insurance number (HIN) (if you do not have their HIN, indicate this)
• Their social insurance number (SIN) (if you do not have their SIN, indicate this)
• Your name, full address and a telephone number to reach you
• The type of relationship with the victim or rescuer, where applicable
• A description of the event
• The place where the event took place
• The date and time of the event. If you do not have the date and time of the event, you can indicate the period, month or year when the event took place
   

You may be asked for a copy of the following documents if they apply to your situation:

• A health assessment from a health professional (dentist, doctor, optometrist or pharmacist) if you are on sick leave, an interruption of studies or unable to carry out most of your usual activities
• A representation mandate or power of attorney if you want to give another person access to your file
• Proof of your relationship to the victim of the criminal offence if you are acting as a significant person
• The victim’s death certificate, if they are deceased
• Proof of your relationship with the victim or rescuer if they are deceased (marriage certificate, birth certificate, etc.)
• Proof of your status (Canadian citizen, permanent resident, etc.) for an offence that took place outside Quebec
• A copy of the judgement rendered if a civil action was brought
• Any other documents you consider relevant (complaint to the police, invoices, etc.)

You can complete an application for qualification for IVAC even if you do not have the documents on hand. You will be asked to send them to us later, since they will be required to process your application.