Application for legal aid If you are deaf or have a hearing or speech impairment, call the NRS on 133 677. If you need an interpreter, call the Translating and Interpreting Service (TIS) on 13 14 50. They can arrange an interpreter to call LawAccess NSW or Legal Aid NSW. Office use only Client ID File ID CASES Number Matter type Criminal Family Civil For help to fill out this form ■ ■ call LawAccess NSW on 1300 888 529 or 1300 889 529 TTY or ■ ■ speak to our staff at a Legal Aid NSW office (listed on the back of this form). l d Use this form to apply for legal aid in New South Wales
Transcript
Application for legal aid
If you are deaf or have a hearing or speech impairment, call the NRS on 133 677.
If you need an interpreter, call the Translating and Interpreting Service (TIS) on 13 14 50. They can arrange an interpreter to call LawAccess NSW or Legal Aid NSW.
Office use onlyClient ID File ID CASES Number Matter type
Criminal Family Civil
For help to fill out this form
■■ call LawAccess NSW on 1300 888 529 or 1300 889 529 TTY or
■■ speak to our staff at a Legal Aid NSW office (listed on the back of this form).
for legal aidUse this form to apply for legal aid in New South Wales
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To see if you are likely to pass the meanstest, use the Means Test Indicator atwww.legalaid.nsw.gov.au
About Legal Aid NSW
How can Legal Aid NSW help me?
Help over the phoneCall LawAccess NSW on 1300 888 529. LawAccess NSWis a free telephone service that provides legal information,referrals and in some cases, advice for people who have alegal problem in NSW.
If you are under 18 and need advice about a criminal lawproblem, or think you might be in trouble with the police youcan call the Youth Hotline on 1800 10 18 10.
Face-to-face legal adviceYou can get free face-to-face legal advice at most Legal AidNSW offices. Legal advice is usually limited to 20 minutes.You should phone your nearest Legal Aid NSW office for anappointment (listed on the back of this form).
Help at courtIf you need ongoing legal help from a solicitor, you needto apply for a grant of legal aid and fill in this applicationform or contact a private solicitor to complete an onlineapplication.
A grant of legal aid provides you with legal representation incourt by a solicitor who works for Legal Aid NSW or a privatesolicitor paid for by Legal Aid NSW.
Legal Aid NSW provides legal assistance for many criminal,family and civil matters. However, we do not provide legalaid for every legal problem.
How do I get a grant of legal aid?Our policies explain the types of matters where legal aidis available and who is eligible for legal aid.
We look at:• what you want legal assistance for• whether it is reasonable in all the circumstances to grant
legal aid (called a merit test)• what you earn and what you own (called a means test).
Who can help me fill out the application form?• LawAccess NSW on 1300 888 529;• Legal Aid NSW staff (by appointment or at an advice
clinic); or• a private solicitor (you may need to pay for this service)
How do I know if I've been granted legal aid?After you send us your completed application form, we willsend you a letter telling you:• if you have been granted legal aid• what the grant is for• any conditions you must meet to get legal aid.
What if I'm not satisfied with the decision?In most matters, if you do not agree with the decision eitherbecause you have been refused legal aid or because you donot agree with the conditions, you can apply to have thedecision reviewed by an independent committee called theLegal Aid Review Committee. Generally you will need to lodgeyour appeal within 28 days.
Is legal aid free?No. A grant of legal aid is not free. You will usually be askedto pay:• some money towards your legal costs at the start of your
case• some or all of your legal costs at the end of your case.
What if my circumstances change?You must tell us immediately if:• you change your address• your financial details or other details change• you become aware of information likely to affect your
eligibility for legal aid• you want to change your solicitor. You cannot change
your solicitor without our agreement.
Need more info about Legal Aid NSW?Visit our website at www.legalaid.nsw.gov.au or contactyour nearest Legal Aid NSW office.
For more information about our policies check out ourA-Z guide to policies or Policy Online atwww.legalaid.nsw.gov.au
If legal aid is available for your type of matter andyou think you are eligible for legal aid, you mustcomplete this application form and send supportingdocumentation.
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Police reference number (CNI number) (if applicable)11
Current NSW driver's licence number12
Go to next questionNo
Have you ever used or been known by any other name?4
What is your other name?Yes
FILLING IN THIS FORM• Please use black or blue pen• Print in BLOCK LETTERS• Mark boxes like this with a or • Where you see a box like this Go to 5 skip to the
question number shown. You do not need to answer thequestions in between
Your name
Other
First name
Middle name
Last name
Mr Mrs Miss Ms
3
What type of legal matter is this application for?2
Criminal Family Civil Don't know
Gender5
Male Female Other
No
Yes
You should seek legal advice before applying for legal aid.• Call LawAccess NSW on 1300 888 529;• Speak to a private solicitor who may then lodge an
online application on your behalf;• Speak to a Legal Aid NSW solicitor at one of our offices.
Have you sought legal advice about your legal problem?
1
You should seek legal advice beforeapplying for legal aid.
Go to next question
Your date of birth6
/ /D D M M Y Y Y Y
7 What is your current relationship status?
Single
Married
De facto
Divorced
Separated
Widowed
Can we communicate with a family member or supportperson?
9
Go to next questionNo
Give details belowYes
Name of the person we can communicate with
You can give us permission to communicate with anotherperson about your application for legal aid and/or your grantof legal aid.
Mobile phone number Relationship to you
Your contact details8
Email address
Residential address
Postcode
Mobile phone number Other phone number
No Yes
Are you homeless or in temporary accommodation?
We prefer to contact you by phone, text (SMS) or email.Please let us know if we can communicate with you by:
Phone calls SMS Email
No Yes No Yes No Yes
Postal address, if different to your residential address
Postcode
Are you in custody/detention?10Go to next questionNo
Give details belowYes
Corrective Services MIN number
Location
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Do you need an interpreter?16Go to next questionNo
Which language do you need an interpreter for?Yes
Do you speak a language other than English at home?15Go to 17No
Which language do you speak at home?Yes
Additional Questions
Financial Details
How did you find out about Legal Aid NSW e.g. internet, court,counsellor, friends, etc?
13
Were you born in another country?14Go to next questionNo
Give details belowYes
Which country were you born in?
What year did you arrive in Australia?
Y Y Y Y
Weekly Fortnightly
Do you currently receive a Centrelink or Department ofVeterans' Affairs benefit or pension?
24
Go to 27No
Give details belowYes
How much do you receive from Centrelink or the Departmentof Veterans' Affairs
$
Which benefit or pension do you currently receivee.g. JobSeeker Payment or Disability Support Pension?
Do you receive the maximum payment?
No Yes Don't know
Attach your Income Statement from Centrelink or astatement from the Department of Veterans' Affairs.
23 Are you currently employed?
Go to next questionNo
What is the basis of your employment?Yes
Casual
Self-employed
Full-time
Part-time
17 Are you of Aboriginal or Torres Strait Islander descent?If you are of both Aboriginal and Torres Strait Islanderdescent, tick both ‘Yes’ boxes.
No
Yes – Aboriginal
Yes – Torres Strait Islander
Do you have a disability?18Go to 20No
What is your disability? (Mark all that apply)Yes
Acquired brain injury
Autism spectrum
Chronic health condition
Cognitive/intellectual
Hearing/speech impairment
Mental health condition
Physical impairment
Vision impairment
Other Give details
What type of disability support do you need from us?19None
Auslan interpreter
Hearing loop
Wheelchair access
Large print documents
Other Give details
Are you a participant in the National Disability InsuranceScheme (NDIS)?
20
No
Yes
Are you currently experiencing or at risk of family violence(including from a former relationship)?
21
No
Yes
Have you used the Means Test Indicator atwww.legalaid.nsw.gov.au to see if you are likely to passthe means test?
22
No You could use the Means Test Indicator atwww.legalaid.nsw.gov.au to see if you arelikely to pass the means test.
Go to next questionYes
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Does the person named in Question 27 currently receive aCentrelink or Department of Veterans' Affairs benefit orpension?
28
Go to next questionNo
Give details belowYes
Which benefit or pension does this person receivee.g. JobSeeker Payment or Disability Support Pension?
Does this person receive the maximum payment?
No Yes Don't know
Attach an Income Statement from Centrelink or astatement from the Department of Veterans' Affairsfor this person.
Weekly Fortnightly
How much does this person receive from Centrelink or theDepartment of Veterans' Affairs
$
How many children do you pay for?
Do you pay child support for any children not living with you?29Go to 30No
Yes Give details below
Weekly Fortnightly$
Total amount of child support paid
Is there anyone e.g. a spouse, partner or relative who givesyou financial help or could assist you financially?
27
Go to 29No
Give details belowYes
What is the full name of this person?
What is your relationship to this person?
Do you agree to Legal Aid NSW checking the details of yourbenefit or pension with Centrelink?
26
Go to next questionNo
Complete the Centrelink consent belowYes
Centrelink consentThis consent will be used for the sole purpose ofauthorising the Australian Government agency, ServicesAustralia (Centrelink) to provide information to Legal AidNSW to assess your eligibility in relation to servicesprovided by Legal Aid NSW.
I authorise Centrelink to electronically provide a statementof information to Legal Aid NSW to assist in the assess-ment of my entitlement to services from Legal Aid NSW.• I understand that the information provided by Centrelink
may include, where relevant, current or historicaldetails of payments received, dependants, Centrelinkdeductions, income, assets and confirmation of mycurrent address.
• I understand that this authority, once signed, is effectiveonly for the period I am a client of Legal Aid NSW.
• I understand that this authority, which is ongoing,can be revoked at any time by giving notice to LegalAid NSW.
• I understand that I will be able to obtain a written copyof the statements at any time from either Legal AidNSW or Centrelink.
For more details about Centrelink Confirmation eServices,go to www.servicesaustralia.gov.au
Note: Agreeing to this will not affect your Centrelinkbenefit or pension.
Your Centrelink Customer Reference Number (if known)
Your signature
Date
/ /D D M M Y Y Y Y
How much of your benefit was suspended?
$
Is your Centrelink benefit currently suspended because ofa lump sum payment?
25
Go to next questionNo
Give details belowYes
A lump sum payment could be a compensation payment,a superannuation payment or a retrenchment payment.
What type of lump sum payment did you receive?
Amount paid
$
Date paid
/ /D D M M Y Y Y Y
Date suspension started
/ /D D M M Y Y Y Y
Date suspension finishes
/ /D D M M Y Y Y Y
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30
Go to next questionNo
Give details of all dependantsYes
Do you or a person who could give you financial help have any dependants?
If there are more than 6 dependants, give details in the space provided on page 15.
A dependant is someone who usually relies on you for financial support e.g. your spouse, partner or child.
First name Last name Date of birth Relationship to you Living with you?
No Yes1.
2.
3.
4.
5.
6.
No Yes
No Yes
No Yes
No Yes
No Yes
/ /D D M M Y Y
/ /D D M M Y Y
/ /D D M M Y Y
/ /D D M M Y Y
/ /D D M M Y Y
/ /D D M M Y Y
Your Expenses
Give details of the expenses paid by yourself and anyperson who could give you financial help.
34
Mark this box if you don't have any expenses
Period
Child care fees $ $
Loans $ $
Other debts $ $
$ $Rates
$ $Board
$ $Mortgage
$ $Rent
Child support $ $
WeeklyFortnightly
WeeklyFortnightly
You Other person
Attach copies of the last income tax return and thefinancial statements of the business or farm for youand any person who could give you financial help.
Period
$ $Income
WeeklyFortnightly
WeeklyFortnightly
You Other person
Are you or a person who could give you financial help, eitherself-employed, a farmer or a business owner?
33
Go to next questionNo
Give details of the income earned belowYes
Do you or a person who could give you financial help,get any other income or benefit?
32
Go to next questionNo
Give details of the other income or benefit belowYes
$Child support
Period
$
$
$
Interest frominvestments
Board/Rent
Superannuation
Income froma trust
Worker'scompensation
Other income
$ $
$ $
$ $
$ $
$ $
You Other person
WeeklyFortnightly
WeeklyFortnightly
Attach copies of last 3 payslips or a letter from youremployer showing the weekly income and tax paidfor you and any person who could give you financialhelp.
Do you or a person who could give you financial help, receivea wage or salary?
31
Go to next questionNo
Give details of the income received belowYes
Period
$ $Net wage/salary(after tax)
You Other person
WeeklyFortnightly
WeeklyFortnightly
Your Income
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How much would the other real estate sell for?
$
Mortgage or amount still owing on the other real estate
$
Do you or a person who could give you financial help ownany other real estate (i.e. an investment property)in Australia or elsewhere (including real estate you arepaying off)?
38
Go to next questionNo
Give details belowYes
Address of the other real estate
Postcode
How much would the farm or business sell for?
$
Mortgage or amount still owing on the farm or business
$
Do you or a person who could give you financial help own afarm or business?
39
Go to next questionNo
Give details belowYes
Address of farm or business
Postcode
$
Make/Model
$
$
$
$ $
Market valueYear Money owing
Do you or a person who could give you financial help,own any motor vehicles (including motor vehicles you arepaying off)?
40
Go to next questionNo
Give details of motor vehicles belowYes
Have you had to move out of your home or buy another homebecause of a disability or health problem?
37
No
Yes
Your Assets
Do you or a person who could give you financial help ownanything else of value in Australia or elsewhere e.g. boats,caravans or shares?
42
Go to 43No
Give details belowYes
$
$
$
Description of item Value
Attach statements for the last 3 months for allaccounts from these financial institution(s) for youand any person who could give you financial help.
Do you or a person who could give you financial help, havea bank account in Australia or elsewhere?
41
Go to next questionNo
Give details belowYes
$
$
$
$
Bank name AmountAccount number
If you are aged 65 years or older, (55 years or older ifyou are of Aboriginal or Torres Strait Islander descent),have you lived in your home for 5 years or more?
36
Go to 38
No Go to next question
Yes
How much would the home sell for?
$
Mortgage or amount still owing on the home
$
Address of the home you are currently living in(write 'as above' if the same as your residential address inQuestion 8)
Do you or a person who could give you financial help,own the home where you are currently living (includinga home you are paying off)?
35
No
Give details belowYes
Postcode
Go to 38
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Are you applying for legal aid for an appeal against adecision of a court or tribunal?
46
Go to 48No
In the appeal, are you the appellant or respondent?Yes
Appellant Respondent
Did you start the legal action for which you are applying forlegal aid?
44
No
Yes
About Your Legal Problem
Court/tribunal reference number
Court/tribunal name
Court/tribunal location (suburb or town)
Are there current court/tribunal proceedings?45Go to next questionNo
Give details belowYes
Attach copies of relevant court documents.
Next court/tribunal date
/ /D D M M Y Y Y Y
Who paid the fees?
How much was paid?
$
Who did you pay the fees to?
Have legal fees previously been paid to a solicitor orbarrister for this matter by you or on your behalf?
49
Go to 50No
Give details belowYes
Are you applying for legal aid for a criminal appeal?47Go to next questionNo
What type of appeal is it?Yes
Sentence Conviction Sentence andconviction
Do you have any other special financial reasons that weneed to consider when making a decision about yourapplication e.g. expenses because of a disability, personaldebts etc?
43
Go to next questionNo
Give detailsYes
Solicitor's name
Firm name
Phone number
Do you have a solicitor that you want to represent you andwho will agree to accept a grant of legal aid (if it is made)?
48
Go to next questionNo
Give details belowYes
Don't know
Address
Postcode
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Tell us about your legal problem and the legal action you want to take or respond to.
Include:• what you want legal aid for• what happened• what the legal problem is• who is involved and how they are involved• how and when the legal problem started• what has happened since then
50
Attach copies of legal, medical or other documents that you think would assist your application
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Please tell us about any exceptional circumstances that you want us to consider when making a decision about your application.52
In some cases, legal aid may be granted to people who have exceptional circumstances. For example, you may have a serious illnessor disability which may make it harder for you to present your case without legal representation.
Attach copies of any relevant documents, e.g. medical reports
Can you give details of the other party(ies) in the matter?51Go to next questionNo
Give details belowYes
If there are more than 2 other parties or co-accused, give details in the space provided on page 15.
For family and civil law matters, provide details of the other person(s) or organisation with whom you are in dispute.For criminal matters, provide details of any other person who has been charged with you (i.e. the co-accused).
Solicitor's name
Firm name
Phone number
Details of the other party or co-accused (if known)
Full name
What is your relationship to this party e.g. partner, employee?
1
Details of the other party/co-accused's solicitor (if known)
Address
Postcode
Address
Postcode
Phone number Date of birth
/ /D D M M Y Y
Solicitor's name
Firm name
Phone number
Details of the other party or co-accused (if known)
Full name
What is your relationship to this party e.g. partner, employee?
2
Details of the other party/co-accused's solicitor (if known)
Address
Postcode
Address
Postcode
Phone number Date of birth
/ /D D M M Y Y
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Complete this section only if you have a criminal law matter
Criminal Law Matters Only
56No
Yes
Do you want legal aid for a Supreme Court bail application?
Go to 58
Go to next question
In which court did you apply for bail?
57No
Yes
Have you already applied for bail?
Go to next question
Give details below
What was the result?
When did you apply for bail?
/ /D D M M Y Y Y Y
Have you been committed for trial/sentence (if applicable)?55No
Yes
Not sure
Have you already pleaded guilty in court to the charge(s)?54No
Yes
Not sure
53Go to 59 – You do not need to answers questions 54 to 58No
Give details of the charge(s)Yes
Do you want legal aid because you have been charged with a criminal offence?
Attach a copy of your charge sheet or court attendance notice (if available)
Description of chargeDate charged How do you want to plead?Criminal chargereference number
H
H
H
H
H
/ /D D M M Y Y
/ /D D M M Y Y
/ /D D M M Y Y
/ /D D M M Y Y
/ /D D M M Y Y
Guilty Not sure yetNot guilty
Guilty Not sure yetNot guilty
Guilty Not sure yetNot guilty
Guilty Not sure yetNot guilty
Guilty Not sure yetNot guilty
Has any of your property been taken or restrained under a proceeds of crime order?58Go to 72 – You do not need to answers questions 59 to 71No
YesAttach a copy of the proceeds of crime order. Go to 72
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Complete this section only if you have a family law or care and protection matter
59Go to 72 – You do not need to answers questions 60 to 71No
Go to next questionYes
Are you applying for legal aid for a family law or care and protection matter?
60Go to next questionNo
Give details of the children affectedYes
Does your matter involve applications or orders affecting children?
If your matter involves more than 6 children, give details in the space provided on page 15.
First name Last name Date of birth Relationship to you Living with you?
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
1.
2.
3.
4.
5.
6.
/ /D D M M Y Y
/ /D D M M Y Y
/ /D D M M Y Y
/ /D D M M Y Y
/ /D D M M Y Y
/ /D D M M Y Y
Family Law and Care and Protection Matters Only
Have your children been removed by Community Services?63Go to 65No
Yes When were the children removed by CommunityServices?
/ /D D M M Y Y Y Y
Were the children living with you when they were removed?64No
Go to 65Yes
Give details of your involvement with the children
Does your matter involve Community Services (formerlyknown as DoCS)?
62
Go to 65No
Yes Go to next question
Name of court/tribunal that made the order
Are there any current court orders about the family lawor care and protection matter (including apprehendeddomestic violence orders, Children’s Court orders or FamilyCourt orders)?
61
Go to next question
Give details below
Attach a copy of the current orders.
Date on which the order was made
/ /D D M M Y Y Y Y
Briefly tell us what the orders say
No
Yes
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65Go to 67No
Give details of the property involvedYes
Does your family law matter involve property?
Description of Property / Property address Market value Amount owed
1.
2.
3.
4.
$
$
$
$
$
$
$
$
Did you attend family dispute resolution at Legal Aid NSW?69No
Yes
Were you married or in a de facto relationship to the personyou are in dispute with?
67
Go to next questionNo
Give details belowYes
Date separated
/ /D D M M Y Y Y Y
Date you were married/relationship started
/ /D D M M Y Y Y Y
Date divorced (if applicable)
/ /D D M M Y Y Y Y
Do you intend to sell the property(ies)?66Go to next questionNo
How do you intend to distribute the funds from thesale of the property(ies)?
Yes
Have you attended family dispute resolution?68Go to 70No
Yes Attach a copy of the certificate/waiver youwere given (if available).
Family Law and Care and Protection Matters Only continued
Has an apprehended domestic violence order been madefor you?
70
Go to next questionNo
What type of apprehended domestic violence orderhas been made for you?
Yes
Interim Final
Attach a copy of the apprehendeddomestic violence order.
Safety concerns72
Do you fear for your safety?
Do you fear for the safety ofyour children?
Are there any currentinvestigations about child abuse?
No Yes
No Yes
No Yes
GivedetailsbelowGivedetailsbelowGivedetailsbelow
If you fear for your safety or the safety of your children,tell us why you are afraid.
Safety Concerns
Has an apprehended domestic violence order been made forthe protection of any children?
71
Go to next questionNo
What type of apprehended domestic violence orderhas been made for the children?
Yes
Interim Final
What part did you play in getting the apprehendeddomestic violence order made for the children?
Applicant Defendant Not a party
Attach a copy of the apprehendeddomestic violence order.
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Checklist Declaration and Privacy
Where do I send this form?75
In person:You can hand the form in at any Legal Aid NSW officelisted on the back page of this form.
Post:Legal Aid NSWGrants DivisionPO Box K847HAYMARKET NSW 1240
Fax:(02) 9219 5533
Make sure that you have completed the checklistand attach all relevant documents.
74
Date
/ /D D M M Y Y Y Y
Your signature
SIGN HERE
Declaration and Privacy
I understand it is an offence to give false or misleadinginformation.
I declare that to the best of my knowledge the information Ihave given is true and correct.
I understand that Legal Aid NSW collects my personalinformation to provide me with a legal service, ensureaccountability for the assistance it provides and to plan andreport on their services.
I understand this information is used and stored by inaccordance with NSW Privacy legislation and I can accessfurther information about the Legal Aid NSW Privacy Policy atwww.legalaid.nsw.gov.au or call (02) 9219 5000.
73Make sure that you attach copies of the following documents:Checklist
You MUST also provide copies of the documentation listedabove for any person who could give you financial help.
Copy of any current court orders(If you answered Yes at Question 61)
Copy of the family dispute resolution certificate/waiver(If you answered Yes at Question 68)
Copy of Apprehended Domestic Violence Order (ADVO)(If you answered Yes at Question 70 or Question 71)
Family law documents
Attach copies of any other relevant legal, medical orother documents that you think would assist yourapplication (See Questions 50 and 52)
Other documents
Copy of charge sheet or court attendance notice(If you answered Yes at Question 53)
Copy of proceeds of crime order(If you answered Yes at Question 58)
Criminal law documents
Sign the Centrelink Consent (if applicable)(See Question 26)
Sign the Declaration (See Question 74)
Signature
Centrelink Statement of Benefit (if you are receivinga Centrelink pension and you did not sign the Consentin question 28) or a statement from the Departmentof Veterans' Affairs (If you answered Yes at Question24 and/or Question 28)
Last 3 months bank statements for all accounts(ATM receipts are not sufficient)(if you answered Yes at Question 41)
3 most recent payslips or a letter from your employershowing your weekly income and tax paid (if you areemployed) (if you answered Yes at Question 31)
Last tax return and financial statements for yourbusiness or farm (if you are self employed)(If you answered Yes at Question 33)
Financial documents
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Use this page if you would like to provide additional information in relation to any of the questions in this form.
