Application for Review

Fields marked with an asterisk
(*)
are required.
 

This form should be completed by an eligible person or organisation who wishes to apply to the Specialist Medical Review Council (SMRC) for review of the contents of a Statement of Principles (SoPs), or a decision made by the Repatriation Medical Authority (RMA) not to make a SoPs or a decision by the RMA not to carry out an investigation under section 196C(4).

It is recommended that you read the Information for Applicants section before completing this form.

If you would prefer to complete this submission on paper please download the PDF filable/savable version of the Application for Review Form.

Applicant's details

Address for correspondence

In submitting this form, I understand that the SMRC may check my eligibility with the Department of Veterans’ Affairs

I would like the Specialist Medical Review Council (SMRC) to review the following RMA decision

Briefly state the grounds (your reasons) on which the review is sought by the SMRC.  If you seek review of a decision of the RMA other than its decision not to carry out an investigation (under section 196C(4)), you will in due course be given the opportunity to make a written submission (and an oral submission complementing the written submission). However, if you seek review of an RMA decision under 196C(4) you need to make any written submission you wish to make in support of your request for review on this form.

In respect to a review requested under 196Y there is provision in the VEA, for a person having expertise in a relevant field to make a written submission.

Your submission should address the following issues:

Attachments

Attach any documents relevant to your request using the upload options below.

Files must be less than 2 MB.
Allowed file types: pdf doc docx.
Files must be less than 2 MB.
Allowed file types: pdf doc docx.
Files must be less than 2 MB.
Allowed file types: pdf doc docx.

When submitting this form, I understand that the SMRC may check my eligibility with the Department of Veterans’ Affairs.