Victim Information Scheme – Online Registration Form

Please read and complete the form below. Once the form has been submitted a confirmation email will be sent to the contact email address you have provided.

Having read the leaflet, I would like to register with the PRVIS / PBNI Victim Information Scheme to receive information about the prisoner / offender.

* required field
URN / CASE REFERENCE (if known):
VICTIM DETAILS
Name:*
Address:*
Street Address * Address Line 2 Town/City * County * Postcode *
Telephone:*
Contact Email Address:
Consent:*
- I give consent to be contacted
REPRESENTATIVE DETAILS
If you are representing the victim, please complete the additional details below:
Name of Representative
Relationship to victim:
Organisation (if applicable):
Address:
Street Address Address Line 2 City County Postcode
Telephone:
Prisoner Release Victim Information Scheme (PRVIS)
In relation to the Prisoner Release Victim Information Scheme please tick all that apply. I wish to receive information on:
- Final Discharge
- Temporary Release Details
PBNI Victim Information Scheme
In relation to the PBNI (Probation) Victim Information Scheme please tick all that apply:
- I would like to meet you
- I would like you to telephone me to discuss issues
- I would like to receive written information
- I require special assistance (For example; disability, language, hearing impairment, etc.)
Please provide details of any special assistance requirements:
Your personal information will be treated in confidence at all times and in accordance with the Data Protection Act.
Name
This field is for validation purposes and should be left unchanged.

VICTIM DETAILS

REPRESENTATIVE DETAILS

Prisoner Release Victim Information Scheme (PRVIS)

PBNI Victim Information Scheme