DPP Referrals

ODPP Referrals

Please complete the below form to submit a new referral to PACT.

"*" indicates required fields

Occurrence (QP) #*

DPP Reference #*

Type of service required*

Complainant / Witness Details

Given name(s) of complainant/witness*

Last name of complainant/witness*

Gender of complainant/witness

Complainant/Witness Date of Birth*

Ethnicity of complainant/witness*

Type of witness*

Relationship to the defendant (offender)*

Address of complainant/witness*

Street Address Address Line 2 State / Province / Region ZIP / Postal Code

Phone number of complainant/witness

Email of complainant/witness

Carer's Details

To be completed for minors only

Carer's given name(s)*

Carer's first and middle name(s)

Carer's last name

Carer's family name

What relationship is the carer to the child?*

Carer's current residential address*

Street Address Address Line 2 State / Province / Region ZIP / Postal Code

Carer's current phone number*

Carer's email address*

Does the complainant/witness have a Child Safety Officer assigned?*

Child Safety Officer Details

Child Safety Officer's given name(s)

Child Safety Officer's last name

Child Safety Office

Child Safety Officer's current phone number

Child Safety Officer's email

Defendant's Details

Defendant's given name(s)*

Defendant's last name*

Defendant's date of birth*

Date of arrest*

Police Officer's Details

Police Officer's given name(s)*

Police Officer's last name*

Rank

Registration number*

Police station*

Police Officer's phone number*

Police Officer's email*

Court / Case Details

Court Event*

Court Jurisdiction*

Date Committed to Higher Court*

Trial number*

For example: Number 1, 2 or 3

Length of trial sittings*

For example: 2 weeks

Court Location*

(e.g. Cairns, Gladstone)

Court Date*

List charges in which complainant/witness is required to give evidence*

Chamber*

Are these historical charges?*

Are there any problems with this case that are not listed on this form?*

Is the complainant/witness required to give evidence?*

Further information

Submitted By

First name of person submitting referral*

Last name of person submitting referral*

Organisation of person submitting referral

Phone number of person submitting referral*

Email of person submitting referral*