This form allows you to provide details about your experience.

Completion does not guarantee inclusion in any class action.

All information is treated confidentially.

FORM STRUCTURE

Section 1 – Personal Details

Full Name
Email
Phone (optional)
Suburb / NSW Region

Section 2 – Police Involvement

Year(s) of involvement
Were you subject to an AVO? (Yes/No)
Were charges laid? (Yes/No)
Were charges withdrawn/dismissed? (Yes/No)
Did police action affect Family Court proceedings? (Yes/No)

Section 3 – Your Story

Long Form Text Field:

Please describe your experience in your own words.
There is no word limit. Approximate dates are acceptable.

Section 4 – Impact

Checkboxes:

Loss of contact with children
Psychological harm
Reputational harm
Financial loss
Other (text field)

Section 5 – Declaration

☐ I confirm this information is true to the best of my knowledge
☐ I understand submission does not guarantee inclusion
☐ I understand this is not legal advice

Button:
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