2. A person claiming compensation under the compensation plan for victims of a Héma-Québec product must apply to the Minister of Health and Social Services by means of a written declaration indicating(1) the name, date of birth and address of the victim who suffered the bodily injury, as well as the victim’s health insurance number;
(2) the person’s name, address and quality, if acting as the victim’s representative or as a person entitled to a death benefit;
(3) the name or nature of the Héma-Québec product giving rise to the application, the place and date of the medical act, and the name of the person who performed the medical act, if known to the applicant;
(4) the date of the first manifestation of symptoms of the bodily injury suffered by the victim;
(5) the date of the victim’s death in the case of an application for a death benefit.