14. An application for reimbursement under section 67 of the Act must be made using the form prescribed by the Minister. The application must contain, in particular, the following information and documents:(1) the name and contact information of the applicant and of their representative, if any;
(2) the amount incurred by the applicant;
(3) the name of the supplier;
(4) a copy of the invoice;
(5) the name and file number of the person who is a victim, as assigned by the Minister, or a description of the criminal offence and the date or period in which it was committed;
(6) the amount reimbursed to the applicant after paying funeral expenses pursuant to the Act respecting the Québec Pension Plan (chapter R-9), if any; (7) a copy of the act of death or death certificate, if any.