(1) This Claim Form is for the submission of a Claim to the Register of Damage Caused by the Aggression of the Russian Federation Against Ukraine in category A2.3 – Serious personal injury.

(2) The determination of whether your Claim is eligible to be recorded in the Register is made by the Board of the Register. Such a determination does not mean that the substance of the Claim or its valuation has been examined, any compensation has been awarded, or any payment to you is due. Examination of your Claim and award of any compensation will be carried out by a future compensation mechanism (within the meaning of the Statute of the Register) that is yet to be established.

(3) Before submitting the Claim, you are encouraged to consult the information about the Register on its website at www.RD4U.claims or www.RD4U.coe.int and the various rules and instructions related to the submission of Claims, in particular – Rules Governing the Submission, Processing and Recording of Claims, Claim Form and Rules: Claims category A2.3 – Serious personal injury, as well as Frequently Asked Questions.

(4) All Claims must be submitted by using Claim Forms approved by the Register for each category of Claims. This Claim Form is to be used for the submission of Claims by natural persons for serious personal injury that occurred on or after 24 February 2022 in the territory of Ukraine within its internationally recognised borders as a result of the Russian Federation’s internationally wrongful acts in or against Ukraine – Claims category A2.3. This Claim Form can also be used for the submission of Claims by natural persons for serious personal injury sustained outside of the territory of Ukraine, but which is directly linked to an event that occurred in the territory of Ukraine. If you wish to submit a Claim for a different type of loss, damage or injury, you should use the Claim Form for the relevant Claims category.

(5) Category A2.3 covers Claims for serious personal injury. “Serious personal injury” means an injury that has caused significant physical or psychological harm or suffering, including but not limited to dismemberment; permanent or temporary significant disfigurement resulting in a substantial change in one’s outward appearance; permanent or temporary significant loss of use or limitation of use of a body organ, limb, function or system; termination of pregnancy; or any other injury likely to significantly impact the quality of life of the injured person.  "Serious personal injury" does not include bruises, simple strains and sprains, minor burns, cuts and wounds or other conditions not requiring a course of medical treatment.

(6) Claims in this category can be submitted by or on behalf of the seriously injured person. The seriousness of the personal injury shall primarily be established by medical documentation and records.

(7) Claims in this category shall include expenses directly related to the serious personal injury, including the costs of medical treatment and rehabilitation borne by the Claimant.

(8) Claims related to other pecuniary consequences of the serious personal injury such as loss of income or gainful employment, shall be submitted in other relevant categories.

(9) Claims related to serious personal injury as a consequence of sexual violence, torture or inhuman or degrading treatment or punishment, deprivation of liberty, or forced labour or service may be submitted either in this category, as a separate Claim, or as part of the categories concerning sexual violence, torture or inhuman or degrading treatment or punishment, deprivation of liberty, or forced labour or service.

(10) Your Claim must be submitted to the Register through Diia web portal at www.diia.gov.ua/services/RD4U. The Register will process and review the Claim and the supporting Evidence and decide whether your Claim is eligible for recording in the Register. You will be informed of the Register’s decision in due course through Diia.

(11) You will be required to submit certain information and Evidence in support of your Claim. Some information will be drawn from various existing electronic sources.

(12) You will be able to submit additional information and upload files with Evidence to support your Claim consistent with the technical requirements of the Register. You will have a chance to check all information before it is submitted to the Register.

(13) You do not need to complete your Claim all at once, and you will be able to save the draft Claim and complete it at a later stage. However, it is advisable to ensure that all the necessary information is prepared and available to you.

(14) You should ensure that the files submitted as part of your Claim are accessible, readable and not infected with computer viruses or any form of malicious software. If the Register identifies any files submitted by you as inaccessible, unreadable or infected, your Claim may not be recorded in the Register.

(15) By submitting your Claim and the supporting Evidence and information, you agree to transfer personal data to the Register and authorise the Register to store, process and transfer such personal data in accordance with the Register’s Principles on the Protection of Personal Data.

(16) Claims by Russian nationals are not eligible to be recorded in the Register. However, Claims by Russian nationals may be recorded in the Register if they can establish that they also hold another nationality.

(17) By submitting your Claim and the supporting Evidence and information, you confirm that they are a truthful representation of your identity as a Claimant, your nationality, your right to make a Claim and the content of the Claim. You understand that submitting an untruthful or false Claim may result in your Claim being considered as manifestly unfounded and not recorded in the Register.