Legal Aid Financial Eligibility Form Instructions
This form contains 240 fields organized into 81 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Applicant Capacity | ||
| Applicant in Representative Capacity - Yes | Radiobutton |
Check this box if the applicant is concerned in a representative, fiduciary, or official capacity only. Fill only if 'Representative name' is filled.
Depends on:
Representative Name
|
| Applicant in Representative Capacity - No | Radiobutton |
Check this box if the applicant is not concerned in a representative, fiduciary, or official capacity. Fill only if 'Representative name' is filled.
Depends on:
Representative Name
|
| Court Orders Costs from Estate - Yes | Radiobutton |
Check this box if it is likely the court would order costs to be paid out of the estate or fund, given the applicant is concerned in a representative capacity. Fill only if 'Applicant in Representative Capacity - Yes' is 'Yes'.
Depends on:
Applicant in Representative Capacity - Yes
|
| Court Orders Costs from Estate - No | Radiobutton |
Check this box if it is not likely the court would order costs to be paid out of the estate or fund, given the applicant is concerned in a representative capacity. Fill only if 'Applicant in Representative Capacity - Yes' is 'Yes'.
Depends on:
Applicant in Representative Capacity - Yes
|
| Bank Overdraft or Personal Debt | ||
| Your Bank Overdraft or Personal Debt | Number |
Please provide the total amount you owe for bank overdrafts or personal debts, including credit cards. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Partner's Bank Overdraft or Personal Debt | Number |
Please provide the total amount your partner owes for bank overdrafts or personal debts, including credit cards. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Bank Overdraft/Personal Debt in Dispute - Yes | Radiobutton |
Check this box if the bank overdraft or personal debt credit cards are currently in dispute. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Bank Overdraft/Personal Debt in Dispute - No | Radiobutton |
Check this box if the bank overdraft or personal debt credit cards are not currently in dispute. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Business/Self-Employed Income | ||
| Your Business Income | Number |
Enter your business or self-employed income amount before tax.
|
| Partner's Business Income | Number |
Enter your partner's business or self-employed income amount before tax. Fill only if 'Do you have a partner who lives with you?' is 'Yes'.
Depends on:
Partner lives with you - Yes
|
| Business Income Frequency | Text |
Enter the frequency for the business or self-employed income (e.g., weekly, monthly, annual).
|
| Cash, Savings and Term Deposits | ||
| Your Cash, Savings and Term Deposits | Number |
Please enter the total value of your cash, savings, and term deposits. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Partner's Cash, Savings and Term Deposits | Number |
Please enter the total value of your partner's cash, savings, and term deposits. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Yes | Radiobutton |
Check this box if your cash, savings, and term deposits are currently in dispute. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| No | Radiobutton |
Check this box if your cash, savings, and term deposits are currently not in dispute. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Children Information | ||
| Number of Children Under 18 | Number |
Please provide the total number of children you have who are under 18 years old.
|
| Number of Children Living With You | Number |
Please provide the number of children under 18 years old who are currently living with you. Fill only if 'Number of Children Under 18' has a value greater than zero.
Depends on:
Number of Children Under 18
|
| Cost Totals | ||
| Total Exclusive of GST | Number |
Enter the total cost for all items listed, excluding Goods and Services Tax (GST).
|
| GST Rate | Number |
Enter the applicable percentage rate for Goods and Services Tax (GST).
|
| GST Amount | Number |
Enter the calculated monetary amount of the Goods and Services Tax (GST).
|
| Grand Total Inclusive of GST | Number |
Enter the grand total cost, including all items and the Goods and Services Tax (GST). Fill only if 'Total Exclusive of GST', 'GST Amount' has a value, on any.
Depends on:
Total Exclusive of GST, GST Amount
|
| Current Address | ||
| Current Address | Text |
Please enter your full current residential address.
|
| Date of Birth | ||
| Date of Birth | Date |
Enter your date of birth.
|
| Debts Question | ||
| Yes | Radiobutton |
Check this box if you or your partner have any debts.
|
| No | Radiobutton |
Check this box if neither you nor your partner have any debts.
|
| Text | ||
| Employer Details | ||
| Your Employer Wages or Salary (before tax) | Number |
Please enter your total wages or salary income from your employer before tax.
|
| Partner's Employer Wages or Salary (before tax) | Number |
Please enter your partner's total wages or salary income from their employer before tax. Fill only if 'Do you have a partner who lives with you?' is 'Yes'.
Depends on:
Partner lives with you - Yes
|
| Employer Wages or Salary Frequency | Text |
Please provide the frequency of the employer wages or salary income, for example, weekly, monthly, or annual.
|
| Fifth Pension or Benefit (Student Allowance) | ||
| Your Student Allowance (before tax) | Number |
Enter the amount of your Student Allowance before tax.
|
| Partner's Student Allowance (before tax) | Number |
Enter the amount of your partner's Student Allowance before tax. Fill only if 'Do you have a partner who lives with you?' is 'Yes'.
Depends on:
Partner lives with you - Yes
|
| Student Allowance Frequency | Text |
Enter the frequency of the Student Allowance payment (e.g., weekly, monthly, annual).
|
| Financial Support Details | ||
| Financial Support Details | Text |
Provide details on how you are financially supported if you do not receive an income. Fill only if 'Your Wages or Salary', 'Partner's Wages or Salary', 'Your Business Income', 'Partner's Business Income', 'Your Working for Families Tax Credits Income', 'Partner's Working for Families Tax Credits Income', 'Your Rent Income Amount', 'Partner's Rent Income Amount', 'Your Interest or Dividends', 'Partner's Interest or Dividends', 'Your Trust Income', 'Partner's Trust Income', 'Your Jobseeker Support Income', 'Partner's Jobseeker Support Income', 'Your Sole Parent Benefit Income', 'Partner's Sole Parent Benefit Income', 'Your Supported Living Payment (before tax)', 'Partner's Supported Living Payment (before tax)', 'Your NZ Superannuation (before tax)', 'Partner's NZ Superannuation (before tax)', 'Your Student Allowance (before tax)', 'Partner's Student Allowance (before tax)', 'Your Other Pension/Benefit Amount', 'Partner's Other Pension/Benefit Amount' are all not filled.
Depends on:
Your Wages or Salary, Partner's Wages or Salary, Your Business Income, Partner's Business Income, Your Working for Families Tax Credits Income, Partner's Working for Families Tax Credits Income, Your Rent Income Amount, Partner's Rent Income Amount, Your Interest or Dividends, Partner's Interest or Dividends, Your Trust Income, Partner's Trust Income, Your Jobseeker Support Income, Partner's Jobseeker Support Income, Your Sole Parent Benefit Income, Partner's Sole Parent Benefit Income, Your Supported Living Payment (before tax), Partner's Supported Living Payment (before tax), Your NZ Superannuation (before tax), Partner's NZ Superannuation (before tax), Your Student Allowance (before tax), Partner's Student Allowance (before tax), Your Other Pension/Benefit Amount, Partner's Other Pension/Benefit Amount
|
| Fines, Tax, or Student Loan Debt | ||
| Your Fines, Tax, or Student Loan Debt | Number |
Please provide the total amount of fines, tax, or student loan debt you owe. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Partner's Fines, Tax, or Student Loan Debt | Number |
Please provide the total amount of fines, tax, or student loan debt your partner owes. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Fines, Tax, or Student Loan Debt is in dispute - Yes | Radiobutton |
Check this box if your fines, tax, or student loan debt is currently in dispute. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Fines, Tax, or Student Loan Debt is in dispute - No | Radiobutton |
Check this box if your fines, tax, or student loan debt is not currently in dispute. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| First Disbursement | ||
| First Disbursement Steps/Stage | Text |
Enter the specific steps or stage relevant to the first disbursement.
|
| First Disbursement Hours Sought | Number |
Enter the number of hours sought for the first disbursement.
|
| First Disbursement Total Dollars (excl GST) | Number |
Enter the dollar amount of the first disbursement, excluding GST.
|
| First Disbursement Total Cents (excl GST) | Text |
Enter the cents amount of the first disbursement, excluding GST.
|
| First High-Value Item | ||
| First Item Description | Text |
Please provide a detailed description of the first high-value item, such as its make, model, or type. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| First Item Value | Number |
Please enter the estimated resale value of the first high-value item. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| First Item Amount Owing | Number |
Please enter the amount still owing on the first high-value item, if it is a vehicle. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Is it in dispute? Yes | Radiobutton |
Check this box if the first high-value item listed has a resale value of $3,500 or more and is currently in dispute. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Is it in dispute? No | Radiobutton |
Check this box if the first high-value item listed has a resale value of $3,500 or more and is not currently in dispute. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| First Income from a Trust | ||
| Your Trust Income | Number |
Please enter the amount of income you receive from a trust, before tax.
|
| Partner's Trust Income | Number |
Please enter the amount of income your partner receives from a trust, before tax. Fill only if 'Do you have a partner who lives with you?' is 'Yes'.
Depends on:
Partner lives with you - Yes
|
| Trust Income Frequency | Text |
Please specify the frequency at which the income from a trust is received, such as weekly, monthly, or annually.
|
| First Other Application | ||
| Other Application Proceedings Type | Text |
Please provide the type of the other application or proceeding.
|
| Other Application Steps/Stage | Text |
Please enter the steps or stage for this other application.
|
| Other Application Hours Sought | Number |
Please enter the number of hours sought for this other application.
|
| Other Application Total (excl GST) | Number |
Please enter the total cost, excluding GST, for this other application.
|
| First Pension or Benefit (Jobseeker support) | ||
| Your Jobseeker Support Income | Number |
Enter the amount of jobseeker support you receive before tax.
|
| Partner's Jobseeker Support Income | Number |
Enter the amount of jobseeker support your partner receives before tax. Fill only if 'Do you have a partner who lives with you?' is 'Yes'.
Depends on:
Partner lives with you - Yes
|
| Jobseeker Support Frequency | Text |
Specify the frequency at which jobseeker support is received (e.g., weekly, monthly, annual).
|
| First Proceedings Type | ||
| Proceedings Type | Text |
Enter the type of proceedings for which funding is sought, such as summary, judgment, or harassment.
|
| Steps or Stage | Text |
Provide a description of the specific steps or stage within this proceedings type.
|
| Hours Sought | Number |
Enter the total number of hours sought for this proceedings type and stage.
|
| Total Exclusive of GST | Number |
Enter the total cost for this proceedings type and stage, excluding Goods and Services Tax.
|
| Fourth High-Value Item | ||
| Fourth High-Value Item Description | Text |
Enter a description of the fourth high-value item. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Fourth High-Value Item Value | Number |
Enter the estimated value of the fourth high-value item in dollars. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Fourth High-Value Item Amount Owing | Number |
Enter the amount owing for the fourth high-value item, if applicable and for vehicles only. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Yes, Fourth High-Value Item in Dispute | Radiobutton |
Check this box if the fourth high-value item listed is currently in dispute. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| No, Fourth High-Value Item not in Dispute | Radiobutton |
Check this box if the fourth high-value item listed is not currently in dispute. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Fourth Other Application | ||
| Disbursement Description | Text |
Provide a detailed description of the disbursement for this entry.
|
| Disbursement Steps/Stage | Text |
Enter the specific steps or stage associated with this disbursement.
|
| Disbursement Hours Sought | Number |
Enter the total number of hours sought for this disbursement.
|
| Disbursement Total (Excl GST) | Number |
Enter the total cost for this disbursement, excluding GST.
|
| Fourth Pension or Benefit (NZ Superannuation) | ||
| Your NZ Superannuation (before tax) | Number |
Please enter your gross NZ Superannuation amount before tax.
|
| Partner's NZ Superannuation (before tax) | Number |
Please enter your partner's gross NZ Superannuation amount before tax. Fill only if 'Do you have a partner who lives with you?' is 'Yes'.
Depends on:
Partner lives with you - Yes
|
| NZ Superannuation Frequency | Text |
Please specify the frequency at which the NZ Superannuation is received, e.g., weekly, monthly, or annually.
|
| Fourth Proceedings Type | ||
| Other Proceedings Type | Text |
Enter the specific type of proceedings categorized as 'Other', for which funding is being sought.
|
| Other Steps/Stage | Text |
Provide a detailed description of the steps or stage for the 'Other' proceedings type.
|
| Other Hours Sought | Number |
Enter the total number of hours sought for the 'Other' proceedings type.
|
| Other Total Amount (excl GST) | Number |
Enter the total amount sought for the 'Other' proceedings type, excluding Goods and Services Tax (GST).
|
| Full Name | ||
| Full Name | Text |
Please enter your complete legal full name.
|
| General | ||
| Your Income from a Trust | Number |
Please enter the amount of income you receive from a Trust before tax.
|
| Your Student Allowance | Number |
Please enter the amount of student allowance you receive before tax.
|
| Button | ||
| Button | ||
| High-Value Items Question | ||
| Yes | Radiobutton |
Check this box if you and/or your partner have any items that have a resale value of $3,500 or more.
|
| No | Radiobutton |
Check this box if you and/or your partner do not have any items that have a resale value of $3,500 or more.
|
| Hire Purchase Debt | ||
| Your Hire Purchase Debt | Number |
Please provide the amount of hire purchase debt you currently owe. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Partner's Hire Purchase Debt | Number |
Please provide the amount of hire purchase debt your partner currently owes. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Hire Purchase Debt in Dispute (Yes) | Radiobutton |
Check this box if your hire purchase debt is currently in dispute. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Hire Purchase Debt in Dispute (No) | Radiobutton |
Check this box if your hire purchase debt is not currently in dispute. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Home Phone | ||
| Home Phone Number | Text |
Please enter your home phone number.
|
| Income from Rent(s) | ||
| Your Rent Income Amount | Number |
Enter the total amount of income you receive from rent(s) before tax.
|
| Partner's Rent Income Amount | Number |
Enter the total amount of income your partner receives from rent(s) before tax. Fill only if 'Do you have a partner who lives with you?' is 'Yes'.
Depends on:
Partner lives with you - Yes
|
| Rent Income Frequency | Text |
Specify how frequently the income from rent(s) is received (e.g., weekly, monthly, annual).
|
| Income Proofs | ||
| Proof of your income | Checkbox |
Check this box if you are attaching proof of your own income, such as payslips, bank statements, WINZ benefit statements, income tax statements, Working for Families documents, or a business set of latest accounts.
|
| Proof of your partner's income | Checkbox |
Check this box if you are attaching proof of your partner's income, such as payslips, bank statements, WINZ benefit statements, income tax statements, Working for Families documents, or a business set of latest accounts. Fill only if 'Do you have a partner who lives with you?' is 'Yes'.
Depends on:
Partner lives with you - Yes
|
| Interest or Dividends | ||
| Your Interest or Dividends | Number |
Please provide the amount of interest or dividends you received before tax.
|
| Partner's Interest or Dividends | Number |
Please provide the amount of interest or dividends your partner received before tax. Fill only if 'Do you have a partner who lives with you?' is 'Yes'.
Depends on:
Partner lives with you - Yes
|
| Interest or Dividends Frequency | Text |
Please specify the frequency at which the interest or dividends are received.
|
| Joint Family Homes Act Question | ||
| Yes | Radiobutton |
Check this box if the property is registered under the Joint Family Homes Act. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| No | Radiobutton |
Check this box if the property is not registered under the Joint Family Homes Act. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Lawyer's Details | ||
| Text | ||
| Text | ||
| Text | ||
| Māori Land Question | ||
| Yes, on Māori land | Radiobutton |
Check this box if the property is on Māori land. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| No, not on Māori land | Radiobutton |
Check this box if the property is not on Māori land. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Mental Health Application Status | ||
| Yes | Radiobutton |
Check this box if the mental health application is for repeat instructions.
|
| No | Radiobutton |
Check this box if the mental health application is not for repeat instructions.
|
| Date of Last Review | Date |
Provide the date of the last review for the mental health application if it is for repeat instructions. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Mobile Phone | ||
| Mobile Phone Number | Text |
Please provide your mobile phone number.
|
| Money or Investments Question | ||
| Yes | Radiobutton |
Check this box if you and/or your partner have any money or investments.
|
| No | Radiobutton |
Check this box if neither you nor your partner have any money or investments.
|
| Negotiation or Settlement Offers | ||
| Yes | Radiobutton |
Check this box if there have been negotiation or settlement offers in this matter.
|
| No | Radiobutton |
Check this box if there have not been any negotiation or settlement offers in this matter.
|
| Details of Offers | Text |
Please provide details regarding any negotiation or settlement offers that have been made in this matter. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Other Contact Phone | ||
| Other Contact Phone Number | Text |
Please provide the other contact phone number.
|
| Other Contact Phone Owner | Text |
Please provide the name of the person whose number is provided as the other contact phone.
|
| Other Debt | ||
| Your Other Debt | Number |
Provide the total amount of any other debts you personally owe. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Partner's Other Debt | Number |
Provide the total amount of any other debts your partner personally owes. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Other Debt - In Dispute: Yes | Radiobutton |
Check this box if the 'Other' debt is currently in dispute. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Other Debt - In Dispute: No | Radiobutton |
Check this box if the 'Other' debt is not currently in dispute. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Other financial information | ||
| Other Reasons for Not Paying Lawyer | Text |
Provide any other reasons that prevent you from being able to pay for your own lawyer.
|
| Lawyer Payment Details | Text |
Provide details if any lawyer has received payments (other than legal aid) or entered into a private fee arrangement for this matter, including the lawyer's name, work completed, and total amount paid.
|
| Other Interested Parties | ||
| RadioButton |
|
|
| Other People Have Interest - No | Radiobutton |
Check this box if there are no other people who have an interest in this matter.
|
| Beneficially Interested Suffer Hardship - Yes | Radiobutton |
Check this box if any beneficially interested person would suffer hardship. Fill only if is 'Yes'.
Depends on:
|
| Beneficially Interested Suffer Hardship - No | Radiobutton |
Check this box if no beneficially interested person would suffer hardship. Fill only if is 'Yes'.
Depends on:
|
| Other Investments | ||
| Your Other Investments | Number |
Please provide the total amount of your other investments, including any money owed to you. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Partner's Other Investments | Number |
Please provide the total amount of your partner's other investments, including any money owed to them. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Other Investments - Yes | Radiobutton |
Check this box if the other investments (including money owed to you) are currently in dispute. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Other Investments - No | Radiobutton |
Check this box if the other investments (including money owed to you) are not currently in dispute. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Other Names Used | ||
| Yes | Radiobutton |
Check this box if you have previously used a name different from your current one.
|
| No | Radiobutton |
Check this box if you have never used a name different from your current one.
|
| Other Names Used | Text |
Please provide any other names you have previously used. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Page 8 | ||
| Date | Date |
Please enter the date.
|
| Partner Information | ||
| Partner lives with you - Yes | Radiobutton |
Check this box if you have a partner who lives with you.
|
| Partner lives with you - No | Radiobutton |
Check this box if you do not have a partner who lives with you.
|
| Partner's Full Name | Text |
Please provide the full name of your partner if they live with you. Fill only if 'Partner lives with you - Yes' is 'Yes'.
Depends on:
Partner lives with you - Yes
|
| Pension or Benefit | ||
| Your Pension or Benefit Amount | Number |
Enter the total pre-tax amount you receive from pensions or benefits.
|
| Partner's Pension or Benefit Amount | Number |
Enter the total pre-tax amount your partner receives from pensions or benefits. Fill only if 'Do you have a partner who lives with you?' is 'Yes'.
Depends on:
Partner lives with you - Yes
|
| Pension or Benefit Frequency | Text |
Enter the frequency at which the pension or benefit income is received, for example, weekly, monthly, or annually.
|
| Postal Address | ||
| Postal Address | Text |
Provide your postal address if it is different from your current address.
|
| Proceedings | ||
| Text | ||
| Yes | Radiobutton |
Check this box if any of the matters subject to the application have been disposed of in court, tribunal, or by any other means. Fill only if 'Has any lawyer received any payments (other than legal aid) or entered into any private fee arrangement for work in regards to this matter?' is 'Yes'.
Depends on:
Lawyer Payment Details
|
| No | Radiobutton |
Check this box if none of the matters subject to the application have been disposed of in court, tribunal, or by any other means. Fill only if 'Has any lawyer received any payments (other than legal aid) or entered into any private fee arrangement for work in regards to this matter?' is 'Yes'.
Depends on:
Lawyer Payment Details
|
| Text |
Depends on:
Yes
|
|
| Text | ||
| Property Details | ||
| Property Address | Text |
Enter the full street address of the property, including unit number, street name, city, state, and zip/postal code. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Legal Owner of Property | Text |
Provide the full legal name(s) of the individual(s) or entity that legally owns the property. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Estimated Value | Number |
Enter the current estimated monetary value of the property. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Mortgage Balance | Number |
Enter the outstanding balance on the property's mortgage. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Property Dispute Question | ||
| Yes | Radiobutton |
Check this box if the property is currently in dispute. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| No | Radiobutton |
Check this box if the property is not currently in dispute. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Property Interest Question | ||
| Yes | Radiobutton |
Check this box if you and/or your partner own or have an interest in a home, land, or other property.
|
| No | Radiobutton |
Check this box if neither you nor your partner own or have an interest in a home, land, or other property.
|
| Property Trust Question | ||
| Trust Property - Yes | Radiobutton |
Check this box if the property is held in a Trust. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Trust Property - No | Radiobutton |
Check this box if the property is not held in a Trust. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Proposed Proceeding Details | ||
| Proposed Proceeding Details | Text |
Provide a comprehensive description of the proposed proceeding(s), including the name of the court or tribunal and its specific location.
|
| Reason for Granting Legal Aid | ||
| Text | ||
| Retirement Funds | ||
| Your Retirement Funds | Number |
Please provide the total value of your retirement funds, excluding Kiwisaver. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Partner's Retirement Funds | Number |
Please provide the total value of your partner's retirement funds, excluding Kiwisaver. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Retirement Funds - In Dispute Yes | Radiobutton |
Check this box if your retirement funds (not Kiwisaver) are currently in dispute. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Retirement Funds - In Dispute No | Radiobutton |
Check this box if your retirement funds (not Kiwisaver) are not currently in dispute. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Second Disbursement | ||
| Second Disbursement Steps/Stage | Text |
Enter a description of the steps or stage for the second disbursement.
|
| Second Disbursement Hours Sought | Number |
Enter the number of hours sought for the second disbursement.
|
| Second Disbursement Total (excl GST) | Number |
Enter the total cost for the second disbursement, excluding GST.
|
| Second Disbursement Additional Total (excl GST) | Number |
Enter any additional total cost for the second disbursement, excluding GST.
|
| Second High-Value Item | ||
| Item Description | Text |
Enter a detailed description of the second high-value item. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Item Value | Number |
Enter the estimated resale value of the second high-value item. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Amount Owing | Number |
Enter the amount of money still owing on the second high-value item, if applicable (for vehicles only). Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Yes | Radiobutton |
Check this box if the second high-value item listed is currently in dispute. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| No | Radiobutton |
Check this box if the second high-value item listed is not currently in dispute. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Second Income from a Trust | ||
| Your Other Income from Trust | Number |
Please provide the amount of other income you receive from a trust before tax.
|
| Partner's Other Income from Trust | Number |
Please provide the amount of other income your partner receives from a trust before tax. Fill only if 'Do you have a partner who lives with you?' is 'Yes'.
Depends on:
Partner lives with you - Yes
|
| Other Trust Income Frequency | Text |
Please provide the frequency of other income received from a trust.
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| Second Other Application | ||
| Text | ||
| Second Other Application Steps/Stage | Text |
Enter the steps or stage involved for the second other application.
|
| Second Other Application Hours Sought | Number |
Enter the total number of hours sought for the second other application.
|
| Second Other Application Total (excl GST) | Number |
Enter the total cost for the second other application, excluding GST.
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| Second Pension or Benefit (Sole parent benefit) | ||
| Your Sole Parent Benefit Income | Number |
Please provide your sole parent benefit income before tax.
|
| Partner's Sole Parent Benefit Income | Number |
Please provide your partner's sole parent benefit income before tax. Fill only if 'Do you have a partner who lives with you?' is 'Yes'.
Depends on:
Partner lives with you - Yes
|
| Sole Parent Benefit Frequency | Text |
Please provide the frequency of the sole parent benefit payment.
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| Second Proceedings Type | ||
| Second Proceedings Type | Text |
Enter the type of proceeding for this cost item, such as summary, judgment, or harassment.
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| Second Steps/Stage | Text |
Provide a description of the steps or stage involved in this cost item.
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| Second Hours Sought | Number |
Enter the number of hours sought for this cost item.
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| Second Total (excl GST) | Number |
Enter the total cost for this item, excluding GST.
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| Share of Ownership | ||
| Share of Ownership | Number |
Provide your percentage share of ownership for the property. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Shares and Bonds | ||
| Your Shares and Bonds | Number |
Please provide the total value of your shares and bonds. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Partner's Shares and Bonds | Number |
Please provide the total value of your partner's shares and bonds. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Shares and Bonds in Dispute (Yes) | Radiobutton |
Check this box if your shares and bonds are currently in dispute. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Shares and Bonds in Dispute (No) | Radiobutton |
Check this box if your shares and bonds are not currently in dispute. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Signature and Representative Details | ||
| Signature Date | Date |
Enter the date on which the application is signed.
|
| Representative Name | Text |
Provide the full name of the representative signing on behalf of the applicant.
|
| Relationship to Applicant | Text |
State the representative's relationship to the applicant.
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| Sixth Pension or Benefit | ||
| Your Other Pension/Benefit Amount | Number |
Enter the amount of other pension or benefit you receive before tax.
|
| Partner's Other Pension/Benefit Amount | Number |
Enter the amount of other pension or benefit your partner receives before tax. Fill only if 'Do you have a partner who lives with you?' is 'Yes'.
Depends on:
Partner lives with you - Yes
|
| Other Pension/Benefit Frequency | Text |
Specify the frequency at which the other pension or benefit is received (e.g., weekly, monthly, annual).
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| Third Disbursement | ||
| Third Disbursement Steps/Stage | Text |
Provide the steps or stage details for the third disbursement entry.
|
| Third Disbursement Hours Sought | Number |
Enter the total hours sought for the third disbursement entry.
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| Third Disbursement Total (Excl GST) | Number |
Enter the total amount for the third disbursement entry, excluding GST.
|
| Disbursements Total (Excl GST) | Number |
Enter the cumulative total amount for all disbursements, excluding GST.
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| Third High-Value Item | ||
| Third High-Value Item Description | Text |
Please provide a description of the third high-value item. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Third High-Value Item Value | Number |
Please enter the value of the third high-value item. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Third High-Value Item Amount Owing | Number |
Please enter the amount owing for the third high-value item, if it is a vehicle. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Third Item in Dispute - Yes | Radiobutton |
Check this box if the third listed high-value item, or its ownership, is currently subject to a dispute. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Third Item in Dispute - No | Radiobutton |
Check this box if the third listed high-value item, or its ownership, is not currently subject to a dispute. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Third Other Application | ||
| Third Other Application Type | Text |
Enter the type of the third 'Other' application, for example, an interlocutory application.
|
| Third Other Application Steps/Stage | Text |
Enter the steps or stage involved in the third 'Other' application.
|
| Third Other Application Hours Sought | Number |
Enter the total number of hours sought for the third 'Other' application.
|
| Third Other Application Total (Excl GST) | Number |
Enter the total cost for the third 'Other' application, excluding GST.
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| Third Pension or Benefit (Supported Living Payment) | ||
| Your Supported Living Payment (before tax) | Number |
Please enter your amount of Supported Living Payment before tax.
|
| Partner's Supported Living Payment (before tax) | Number |
Please enter your partner's amount of Supported Living Payment before tax. Fill only if 'Do you have a partner who lives with you?' is 'Yes'.
Depends on:
Partner lives with you - Yes
|
| Supported Living Payment Frequency | Text |
Please provide the frequency of the Supported Living Payment, such as weekly, monthly, or annually.
|
| Third Proceedings Type | ||
| Proceedings Type | Text |
Enter the type of legal proceedings, for example, summary, judgment, or harassment.
|
| Proceedings Steps/Stage | Text |
Describe the specific steps or stage involved in this proceeding type.
|
| Hours Sought | Number |
Provide the total number of hours sought for this proceeding type.
|
| Total Excl GST | Number |
Enter the total cost for this proceeding type, excluding GST.
|
| Title | ||
| Miss | Radiobutton |
Check this box if your title is Miss.
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| Ms | Radiobutton |
Check this box if your title is Ms.
|
| Mrs | Radiobutton |
Check this box if your title is Mrs.
|
| Mr | Radiobutton |
Check this box if your title is Mr.
|
| Trust Debt Inquiry | ||
| Yes | Radiobutton |
Check this box if the Trust owes money to you and/or your partner.
|
| No | Radiobutton |
Check this box if the Trust does not owe money to you and/or your partner.
|
| Amount Trust Owes | Number |
Enter the total amount of money the Trust owes to you and/or your partner. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Trust Documents | ||
| Have Interest in Trust | Checkbox |
Check this box if you have an interest in a Trust and are attaching supporting documents. Fill only if 'Is it in a Trust?' is 'Yes'.
Depends on:
Trust Property - Yes
|
| Copy of Original Trust Deed | Checkbox |
Check this box if you are attaching a copy of the original Trust deed. Fill only if 'Have Interest in Trust' is 'Yes'.
Depends on:
Have Interest in Trust
|
| Copy of Latest Financial Accounts for Trust | Checkbox |
Check this box if you are attaching a copy of the latest financial accounts for the Trust. Fill only if 'Have Interest in Trust' is 'Yes'.
Depends on:
Have Interest in Trust
|
| Trust Payout Timing | ||
| Expected Payout Date | Date |
Please specify when you expect to receive this money from the trust. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Don't know | Radiobutton |
Check this box if you do not know the exact date you will receive the money from the Trust. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Wages or Salary | ||
| Your Wages or Salary | Number |
Please enter the amount of wages or salary you receive before tax.
|
| Partner's Wages or Salary | Number |
Please enter the amount of wages or salary your partner receives before tax. Fill only if 'Do you have a partner who lives with you?' is 'Yes'.
Depends on:
Partner lives with you - Yes
|
| Wages or Salary Frequency | Text |
Please specify the frequency at which the wages or salary are received, for example, weekly, monthly, or annually.
|
| WINZ Debt | ||
| Your WINZ Debt | Number |
Enter the amount of WINZ debt you personally owe. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Partner's WINZ Debt | Number |
Enter the amount of WINZ debt your partner personally owes. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| WINZ Debt in Dispute Yes | Radiobutton |
Check this box if the WINZ debt is currently in dispute. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| WINZ Debt in Dispute No | Radiobutton |
Check this box if the WINZ debt is not currently in dispute. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| WINZ Number | ||
| WINZ Number (First Part) | Text |
Please provide the first part of your WINZ number.
|
| WINZ Number (Second Part) | Text |
Please provide the second part of your WINZ number.
|
| WINZ Number (Third Part) | Text |
Please provide the third part of your WINZ number.
|
| Work Phone | ||
| Work Phone Number | Text |
Please provide your work phone number.
|
| Working for Families Tax Credits | ||
| Your Working for Families Tax Credits Income | Number |
Please provide your income from Working for Families Tax Credits before tax.
|
| Partner's Working for Families Tax Credits Income | Number |
Please provide your partner's income from Working for Families Tax Credits before tax. Fill only if 'Do you have a partner who lives with you?' is 'Yes'.
Depends on:
Partner lives with you - Yes
|
| Working for Families Tax Credits Income Frequency | Text |
Please specify the frequency of the Working for Families Tax Credits income (e.g., weekly, monthly, annual).
|