1 For what type of problem do you need Legal Aid?
Family  Criminal  Civil/General 

2 When is the next court date (if you know)? 

3 Given names  Family name 

4 Title Mr Ms  Mrs  Miss  Other Give details: 

5 Do you use or have you used other names?
No Go to question 6
Yes  Please give other name: 

6 Your sex  Male Female  Not applicable (For example, a group or organisation)

7 Your date of birth 

8 Your home address (even if you are in custody)

Postcode 

Should we send mail to you at your home address?

No  Where can we send mail to you?

Postcode 

Yes  Go to question 9

9 Your phone numbers
Home 
Work 
Other contact number  

10 Have you applied for legal aid before?
No  Go to question 11
Yes  What year? 

11 Is this application being made for someone else?
No  Go to question 12
Yes  Is it for:

Separate representative
Child in criminal matter
Child in welfare matter
Mental health matter
Next friend
Request by Court/Tribunal
Other   Give details: 

Please tell us your details so we can contact you about this application:
Name 
Address 

Postcode  Telephone

12 Are you in custody or detention?
No  Go to question 13
Yes   Where?Gaol/centre 

Section  Prisoner's Identification Number 

13 Were you born overseas?
No  Go to question 14
Yes  Give details:

What country were you born in? 
What year did you arrive in Australia? 

14 Do you speak a language other than English at home?
No   Go to question 15
Yes    Which language? 

Do you need an interpreter?
No   Go to question 15
Yes    Which language?

15 Are you an Aboriginal or Torres Strait Islander?
No   Go to question 16
Yes   Go to question 16

16 Do you get Austudy or Abstudy?
No   Go to question 17
Yes   Go to question 17

17 Are you a full-time member or ex-member of the Australian Defence Services or a dependant of one?
No   Go to question 18
Yes   Go to question 18

18 What are your living arrangements?
Married    Married but separated    Divorced    Living in a defacto relationship   
Widowed    Living with other partner    Never married    Defacto but separated   
Other   Give details: 

19 List your dependants, include spouse/defacto/partner/children
Then go to question 20

20 Do you get a pension or benefit?
No   Go to question 21
Yes   Which one?

Age  Sole Parent  Disability  Unemployment  Widow 
Veterans  Sickness  Special  Other  Give details: 

21 How much do you or any financially associated person get from any pension, benefits or allowance?
Do not include Family Payment or Child Disability Allowance.

You must give us copies of the Pension or Health Care Cards.

22 Are you employed?
No    When did you last do paid work?   Go to question 23
Yes    Go to question 23

23 What work do you usually do? 

24 Do you or a financially associated person receive a wage or salary?
No   Go to question 25
Yes   Please give amount of income per week:

You must give us copies of recent payslips or letters from employers setting out weekly income and tax paid.

25 Do you or a financially associated person get any other income or benefit?
No   Go to question 26
Yes   Please give type of income or benefit and amount you receive weekly:

26 Are you, a financially associated person or any of your dependant children :
Self-employed    A primary producer (farmer,grazier)    A partner in a business 
A director/shareholder in a business or company  Receiving money from a trust 
Receiving any benefit from a business or company? For example, use of a car, telephone, payment of school fees. 
(You may be required to provide extra information such as tax returns).
None of the above  Go to question 27

27 What sort of housing payments do you make or are made on your behalf by a financially associated person?

Do not pay housing costs   Give details: 

28 Do you or a financially associated person pay any of the following expenses each week?
No   Go to question 29
Yes Give details:

30 Do you or a financially associated person own your home in Australia or elsewhere? Including a home you are paying off
No   Go to question 31
Yes   Give details:
Address (if different to your home address)

Postcode  How much would the home sell for? $
Mortgages or amount still owing on the home you own $

31 Do you or a financially associated person own any other real estate in Australia or elsewhere? Including real estate you are paying off
No   Go to question 32
Yes Give details:

How much would it sell for? $
Mortgages or amount still owing on this property: $
Address 

Postcode 

32 Do you or a financially associated person own any motor vehicles? Including motor vehicles you are paying off
No   Go to question 33
Yes   Give details:

Your vehicles

Year	Model	Market Value	Money Owing
		$	$
		$	$

Other person's vehicles

Year	Model	Market Value	Money Owing
		$	$
		$	$

33 Do you or a financially associated person have an account with a bank, building society or credit union in Australia or elsewhere, or have money invested with other persons?
No   Go to question 34
Yes   Give details of your accounts:

Your accounts

Bank/building society/credit union	Amount
	$
	$

Other person's accounts

Bank/building society/credit union	Amount
	$
	$

34 Do you or a financially associated person have any cash?
No   Go to question 35
Yes   Give details:

Your cash $ 
Other person's cash $

35 Do you or a financially associated person own anything else of value in Australia or elsewhere? For example, shares, bonds, boats, caravans, jewellery, insurance or superannuation policies
No   Go to question 36
Yes   Give details:

Your property

Item	Value
	$
	$

Other person's property

Item	Value
	$
	$

36 Does anyone owe money to you or a financially associated person?
No   Go to question 37
Yes   Give details:

Money owed to you

From who	Amount
	$
	$

Money owed to the other person

From who	Amount
	$
	$

37 During the last 12 months, have you or a financially associated person sold or given away any money or property in Australia or elsewhere worth more than $500?
No   Go to question 38
Yes   Give details:

38 Did you or a financially associated person get any lump sum amount(s) of money greater than $500 in the last 12 months? For example, a loan, gift, compensation, redundancy, award from a court case
No   Go to question 39
Yes   Give details:

39 Are you or a financially associated person likely to get any lump sum amount(s) of money in the next 12 months? Like a loan, gift, compensation, redundancy, award from a court case
No   Go to question 40
Yes    What? 

40 Has any person or group paid any of your legal fees for this case?
No   Go to question 41
Yes   Give details:

41 Can any person or group pay for your legal fees?
No   Go to question 42
Yes    Who? 

42 Briefly explain your legal problem.

For criminal matters—what offences are you charged with?

For all matters—give details

Use the last page if you do not have enough room. Please attach copies of any documents, summonses or charge sheets relating to this matter. Do not give us originals.

43 Are there current court proceedings?
No   Go to question 44
Yes   Give details:

When is the next court date? 
Which court or tribunal do you have to appear in (for example, Family, Supreme, Administrative Appeals Tribunal? 
Where is the court/tribunal? Town and State 

44 Are you applying for legal aid to appeal against a decision of a court or tribunal?
No   Go to question 45
Yes   Give details:

Which court or tribunal made the decision? 
Where is that court or tribunal? Town and state 
What was the date of the original decision? 

45 In respect of this application, who do you want your lawyer to be? In some cases, you may not get the lawyer you choose
A Legal Aid lawyer    Name if known: 
A private lawyer    Give details:

Name 
Firm 
Address 

Postcode  Telephone 

No preference 

Go to question 46

46 If your legal problem is:
Family Law   Go to question 47
Criminal Law    Go to question 52
Civil/General Law    Go to question 55

47 Provide details of the person(s) you are in dispute with
Full name 
Date of birth 
Their address 

Postcode 
Their phone number 

Their lawyer's name 
Their lawyer's address 

Postcode 

48 Were you married to the person you are in dispute with?
No   Go to question 49
Yes    Date of marriage 

Date of separation 
Date of divorce 

49 Were you in a defacto relationship with the person you are in dispute with?
No   Go to question 50
Yes    Date relationship started 

Date of separation 

50 Have you been to counselling/mediation?
No   Go to question 51
Yes    Give details

Name of agency    Date 

51 Are there existing court orders in relation to this dispute?
No   Go to question 59
Yes   Attach copies. Go to question 59

52 Was anyone else charged with you for these offences?
No   Go to question 53
Yes   Please give their names

53 Have you been committed for trial?
No   Go to question 54
Yes   Go to question 54

54 Do you have any prior convictions?
No   Go to question 59
Yes  Give details:

Go to question 59

55 Please give the date and place where your accident or problem happened
Date  Place 
Go to question 56

56 Who are you in dispute with? Please give details if known
Name 
Address 

Postcode 

57 Are you insured against any part of this claim/loss?
No   Go to question 58
Yes   Give details:

Name of insurer 
Address of insurer 

Postcode 

58 Can you estimate the amount of your claim/loss?
No   Go to question 59
Yes  Amount $  Go to question 59

59 All applicants must sign the Declaration.

I (name): 
of (address): 

Postcode 

acknowledge that it is an offence to:
• Fail to provide information required of me and which is relevant to this application for legal aid.
• Provide a document to the Commission in connection with this application for legal aid that is false or misleading.
• Make a false or misleading statement either orally or in writing in relation to this application for legal aid.

I therefore declare that all the information I have given is true and correct.

Applicant's (Your) Signature 

Date 

NOTE: If this application is made through a solicitor, this certificate MUST be completed. If not, it may be interpreted as an expression of opinion that the application has no merit.

I (name): 
of the firm of: 
of (address): 

Postcode

CERTIFY that the applicant has consulted me and I am of the opinion that this application has legal merit and/or is otherwise deserving of aid.

Solicitor's Signature 

Date 

You have now completed your application for legal aid.
Send the actual application form to Legal Aid.
Important : ensure that all relevant material such as means verification is attached to the application