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 A4.1 – Loss of access to healthcare.  
  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 the Claims, in particular – Rules Governing the Submission, Processing and Recording of Claims, Claim Form and Rules: Claims category A4.1 – Loss of access to healthcare, 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 submission of Claims by natural persons who lost or were prevented from obtaining access to healthcare in the territory of Ukraine within its internationally recognised borders on or after 24 February 2022, as a result of the Russian Federation’s internationally wrongful acts in or against Ukraine – Claims category A4.1. 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 A4.1 covers Claims for the loss of access to healthcare. “Healthcare” means the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. “Access” to healthcare means the ability to obtain such services and includes the right for everyone to use relevant services, institutions, and items without discrimination. “Loss of access” is defined as the inability to obtain healthcare services over a sustained period of time due to damage or destruction of healthcare facilities, physical separation from such facilities, unavailability of medical personnel,  or any other reason resulting from the Russian Federation’s aggression against Ukraine.
  6. Claims in this category can be submitted for the loss of access to healthcare which led to a serious, rapid or irreversible decline in the Claimant’s state of health resulting in intense suffering or to a significant reduction in life expectancy, and for expenses that a Claimant had to make to mitigate the risk of their occurrence (such as additional travel costs and higher costs of treatment).
  7. Claims related to other pecuniary consequences of the loss of access to healthcare, such as the loss of income or gainful employment, shall be submitted in other relevant categories.
  8. Claims for serious personal injury (including expenses directly related to the serious personal injury) which are a direct result of an internationally wrongful act of the Russian Federation shall be submitted in category A2.3 – Serious personal injury. Claims for the death of an immediate family member shall be submitted in category A2.1 – Death of an immediate family member. Claims for other violations of international human rights law, international humanitarian law or laws and customs of war shall be submitted in category A2.10 – Other violations of international human rights law, international humanitarian law or laws and customs of war.
  9. Claims by the State of Ukraine for the damage or destruction of hospitals or medical facilities (including pharmacies) shall be submitted in category B1.1 – Damage or destruction of critical infrastructure. Claims by legal entities other than the State of Ukraine for the damage or destruction of hospitals or medical facilities (including pharmacies) shall be submitted in category C1.1 – Damage or destruction of critical infrastructure.
  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, including information concerning the events related to the loss of access to healthcare. 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.