Statement on Restitution (SJ-1021B)

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Statement on Restitution SJ-1021BThis form must be used by any person wishing to file a request for restitution as the result of an offence committed after July 22, 2015.

Version: July 2015

Type of File:dynamic pdf

Minimum required version of Adobe Reader : 7


More information

Only forms with a duly completed File number section that concern an offence committed after July 22, 2015 will be processed.

A copy of all the supporting documents for the loss or damage resulting from the offence (receipts, bills, estimates or other relevant documents) must be submitted with this form. 

Provide only a photocopy of the supporting documents. Keep the originals for your records. 

Contact the police force responsible for investigating the offence for more details concerning the information required in the File identification section.

Contact the Ministère or a victim of crime assistance centre (CAVAC) if you have any other questions concerning the form.

Send the form to the clerk’s office at the Court of Québec, Criminal and Penal Division, in the judicial district where judicial proceedings were instituted against the accused.

A printed version of the form may be obtained from a victim of crime assistance centre (CAVAC).  

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