CANADIAN BENEFIT FOR PARENT OF YOUNG VICTIMS OF CRIME INCIDENT REPORT FORM

This form will be used to confirm that the child has died or is missing as a result of a probable Criminal Code offence (referred to in the form as the “incident”), the date of the incident, that the incident occurred in Canada and whether the applicant has been charged with an offence that led to the death or disappearance of the child. Service Canada may contact the Law Enforcement Agency to confirm or update the information provided in this form and may seek additional information for the purposes of administering this grant.