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Legal Assistance Referral Scheme - Application
Current
Personal Details
Authorised Person
Legal Aid
Other Schemes
Type of Matter
Financial Information
Acknowledgement
Complete
Indicates required field
Title
Title
- Select -
Mr.
Mrs.
Ms.
Miss.
Other...
Enter other title
Gender
- Select -
M
F
T
Prefer not to say
Name
Please enter your full name
Street Address
Suburb or Town
Postcode
Date of Birth
Email
Mobile Phone
Work Phone
Home Phone
Relationship Status
Relationship Status
- Select -
Single
Partnered
Defacto
Other…
Enter other marital status…
Number of children or dependants
Number of people living in your house and their relationship to you?
What type of housing do you live in? eg (rented apartment, own home, public housing, student accommodation)
Do you currently work? If yes, what is your occupation?
Do you identify as Aboriginal or Torres Strait Islander?
Yes
No
Country of Birth
Are there any circumstances which make it more difficult for you to deal with your legal problem?
(This may include; you require an interpreter; have a disability or impairment; cultural or religious reasons; you are experiencing domestic violence; you have been a victim of crime, you have on ongoing physical or mental illness, or you are being held in a prison or detention centre. Please provide us with as much information as possible)
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