Counselling And Report Fee Invoice V2 - Form 5

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Practice Directions 1/2008 and 2/2008
Form 5
V2 22 Oct 08)
COUNSELLING AND REPORT FEE INVOICE
Victims of Crime
Assistance Tribunal
Section 1: Applicant Details
Applicant name
Tribunal reference number
Tribunal venue
Section 2: Counsellor / Report Writer Details
Name of report writer/counsellor
Name of business / agency
Must be the entity name as recorded against the Australian Business Number (ABN) to
enable payment to be made by the Department of Justice
ABN of business / agency
Postal/payment address of
business / agency
Cheque will be sent to this address if non-EFT payment
Counsellor reference
Section 3: Counselling Fees Claimed
Date of
Duration of
Signature of Counsellor
Signature of Applicant
Fee Claimed
counselling
session
(to be signed at conclusion of each
(to be signed at conclusion of each
(inc. GST)
counselling session)
counselling session)
session
(Hr:Min)
(refer to Tribunal’s
Costs Guideline)
Date signed:
Date signed:
Date signed:
Date signed:
Date signed:
Date signed:
Date signed:
Date signed:
Date signed:
Date signed:
Date signed:
Date signed:
Section 4: Report Fee Claimed
Report Description
Fee Claimed (inc. GST)
(e.g., date of report, report type, time spent preparing report)
(refer to Tribunal’s Costs
Guideline)
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