Claim Withdrawal Form

Form Instructions

Claimants wishing to withdraw their claim should complete this form and return it to:
Virginia Victims Fund
P.O. Box 26927
Richmond, VA 23261

Via fax: 804-823-6905
Via email: info@vvf.virginia.gov

Claimants may withdraw their claim at anytime for a variety of reasons, including:

  • Other resources are available such as insurance, discounted billing by providers
  • No longer interested
  • Cannot find supporting documentation