Permission for Verbal Communications
Form Description
The Virginia Victim Fund protects claimants’ information by verifying all callers. VVF staff will only discuss claims with third parties that are authorized by the claimant in this form.
Form Instructions
The claimant will provide the name, relationship, and last 4 of Social Security Number for anyone with whom they will permit VVF to discuss claim information. This form must be completed in its entirety or it is not valid.
Fax or mail to:
Virginia Victims Fund
P.O. Box 26927
Richmond, VA 23261
Fax: 804-823-6905
Download Permission for Verbal Communications - Arabicتنزيل إذن التواصل اللفظي - العربية
Download Permission for Verbal Communications - SpanishDescargar Permiso para Comunicaciones Verbales - Español
Download Permission for Verbal Communications - VietnameseTải xuống Quyền cho Giao tiếp bằng lời nói - Tiếng Việt
Download Permission for Verbal Communications - Chinese Simplified下载口头通讯许可 - 简体中文
Download Permission for Verbal Communications - Chinese Traditional下載口語交流許可 - 繁體中文
Download Permission for Verbal Communications - Korean언어적 의사소통을 위한 다운로드 허가 - 한국어
The Virginia Workers’ Compensation Commission can only accept filings submitted in English.