Individual Payment - Application Form

Please Note you must only submit one application per impacted household

2026 Victorian Bushfire Appeal

Collection Notice

The Victorian Emergency Relief and Recovery Foundation (VERRF) and the Department of Justice and Community Safety (DJCS) is collecting personal information about you in order to confirm your eligibility for a once off relief payment per household. We will require your banking details (BSB, account number and account name) in order to make the payment. Any personal information collected by DJCS will be handled in accordance with the requirements of the Privacy and Data Protection Act 2014, the Health Records Act 2001 and the Public Records Act 1973. DJCS will share information with the VERRF and may share your information with local councils, Department of Families, Fairness and Housing (DFFH) or other areas within DJCS to verify the details you have provided and confirm your eligibility for a once off relief payment. If you do not provide the requested details, we may be unable to confirm your eligibility and provide you with a payment. You can gain access to the information we hold about you by making a Freedom of Information request (visit www.justice.vic.gov.au). If you have any concerns or questions, you can contact the Victorian Emergency Relief and Recovery Foundation (VERRF) via email at VERRF@justice.vic.gov.au.

Personal Information

Given name *

Surname *

Address of impacted property *

Street address *

City *

State *

Postcode *

Residential status at impacted property *

Please specify *

Number of occupants within the household at impacted property *

Current address *

Street address *

City *

State *

Postcode *

Contact number *

Email address *

Australian residency type *

Please specify *

Was your primary place of residence deemed uninhabitable as a direct result of a bushfire? *

Victorian Bushfire Reference *

Please specify *

Your local council *

Please specify *

Banking details for payment

Note: The account must be in your name, or a joint account including your name. Providing these details with your application will streamline processing. If you are unable to provide this information, we will contact you at a future date.

Account held in the name(s) of

Branch Number (BSB)

Account Number

Evidence impacted property was y our primary place of residence

Note: You are required to verify that the dwelling impacted by the Victorian bushfire was your main residence/primary place of residence. This can be demonstrated by providing evidence that mail is delivered to you at that address, it matches your address on the electoral roll, or you have utility bills addressed to you. Two different types of evidence that show your name and address, will be required to assist in the verification process.

Copy of your driver's license or similar government documentation with name and address *

Browse

Copy of your utility bill/bank statement (clearly shows name and address)

Browse

Other

Browse

Application Declaration

Please ensure that you read and fully understand each of the following statements.

I understand that the VERRF is obligated to maintain financial and operational records relating to receiving and dispersing donated funds to uphold its registration, and that this requires the information provided in this application being retained *

Yes

I consent to my details being verified with local councils, Department of Families, Fairness and Housing (DFFH), Department of Justice and Community Safety (DJCS) or another government department, if required. *

Yes

I understand that the VERRF may contact me to seek clarification of any information provided in this application, including requesting further supporting material. *

Yes

I understand that all personal information contained in this application will be collected and used as set out in the DJCS Privacy Collection Notice. *

Yes

I understand that the application and disbursement process may take some time before I receive written notice of the outcome. *

Yes

I hereby confirm that all information contained within this application is true and accurate. *

Yes

Signature

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Date *

Additional Support

For more information on further available grants and support please visit January 2026 Victorian bushfires [here]. For assistance with replacing goods and other items contact GIVIT [here].

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