Legal Aid Queensland application form (LAQAPP) Instructions

Check this box if you identify as Torres Strait Islander (if you identify as both Torres Strait Islander and Aboriginal, tick both the Torres Strait Islander and Aboriginal boxes).

Check this box if you identify as Aboriginal (if you identify as both Aboriginal and Torres Strait Islander, tick both the Aboriginal and Torres Strait Islander boxes).

Check this box if you do NOT identify as Aboriginal or Torres Strait Islander.

Provide any extra information about your family, relationship or civil law problem related to question 18; include names, dates, circumstances and any other details that will help explain your situation.

Check this box if you are aged 17 years or younger.

Check this box if you are older than 17 years.

Enter the applicant declaration details for item 1 — provide the required short statement or identifier (for example your name, signature reference or brief confirmation that the information in this form is true and correct).

Enter the date when the applicant or authorised person signed this authority.

Enter the full signature of the applicant or authorised person signing this authority.

Enter the authority you have to complete this application for someone else (for example: power of attorney, QCAT order, parent, guardian) and any brief supporting details. Fill only if 'No — What authority do you have to complete this application for someone else?' is 'No'.

Enter the full name of the applicant or the authorised person who is signing this authority.

Check this box if the person is currently in custody and wants to apply for bail.

Check this box if the person is currently in custody and does not want to apply for bail.

Enter your date of birth.

Enter the name of the country where you were born. Fill only if 'Born in Another Country - Yes' is 'Yes'.

Check this box if you WERE born in another country and will provide the country name.

Check this box if you were NOT born in another country (i.e. you were born in this country).

Check this box when you are indicating/providing the name of the country where you were born (used with the country name field).

Enter the specific offence or charge for the fifth item (for example the offence name, short description or relevant statute). Fill only if 'Question 11 - Yes (charged)' is 'Yes'.

Enter the date you were charged for the fifth listed offence. Fill only if 'Question 11 - Yes (charged)' is 'Yes'.

Provide the name or brief description of the offence(s) for the first charge (for example the offence title, statute or short description). Fill only if 'Question 11 - Yes (charged)' is 'Yes'.

Enter the date you were charged for the first listed offence. Fill only if 'Question 11 - Yes (charged)' is 'Yes'.

Provide a brief description or name of the offence for the fourth listed charge (e.g., theft, assault). Fill only if 'Question 11 - Yes (charged)' is 'Yes'.

Enter the date you were charged for the fourth listed offence (day/month/year). Fill only if 'Question 11 - Yes (charged)' is 'Yes'.

Enter the date when the second charge was laid against you (the date the offence was officially recorded). Fill only if 'Question 11 - Yes (charged)' is 'Yes'.

Provide a brief description or name of the offence for the second charge as listed by the charging authority. Fill only if 'Question 11 - Yes (charged)' is 'Yes'.

Enter the date you were charged for the third listed offence. Fill only if 'Question 11 - Yes (charged)' is 'Yes'.

Enter the name and a short description of the third offence you were charged with (for example the offence title, any relevant statute or charge code, and brief context). Fill only if 'Question 11 - Yes (charged)' is 'Yes'.

Check this box if you will provide additional details about your charges in the response to question 18.

Check this box if you are attaching photocopies of any court documents you have received or filed.

Check this box when you are attaching a Queensland Police Service court brief (QP9) or related criminal/traffic history documents, notice to appear, or proceeds of crime order to your application.

Check this box if you have attached any court orders, family dispute resolution certificates, or an invitation to attend a family dispute resolution conference to your application.

Check this box after you have completed and reviewed every question on the form, making sure you have answered all relevant questions including question 18 on page 13.

Check this box after you have read the Declaration and authority to release information on page 14 and have signed it where required.

Check this box if you have attached a Centrelink income statement as evidence of your income.

Check this box if you have attached payslips for at least the last four weeks or a letter from your employer confirming your income.

Check this box if you have attached copies of bank statements covering the past three months for every financial institution where you hold accounts.

Check this box if you have attached documentation proving your self-employed income (for example business records or tax documents).

Check this box if you do not have any children under 18.

Check this box if you have one or more children under 18, and then provide their details in the table below.

Enter a short title, label or identifier for your first civil law problem (for example a case name, brief subject or a short reference) so this problem can be easily distinguished from others.

Enter the given (first) name of the person who made the complaint against you. Fill only if 'Not sure' is 'No'.

Enter the family (last) name or surname of the person who made the complaint against you. Fill only if 'Not sure' is 'No'.

Check this box if you do not know or are unsure who made the complaint(s) against you.

Check this box to indicate that additional details about the complainant(s) are provided at question 18.

Check this box if you are completing the application on behalf of another person and then provide the authority (for example power of attorney, QCAT order, parent or guardian) in the space provided.

Check this box if you are completing this application for yourself and will read and sign the declaration shown below.

Check this box if you do NOT consent to Police Prosecutions giving Legal Aid Queensland a copy of your Queensland Police Service Court Brief (QP9) and/or your criminal and traffic history.

Check this box if you DO consent to Police Prosecutions giving Legal Aid Queensland a copy of your Queensland Police Service Court Brief (QP9) and/or your criminal and traffic history.

Enter the area/STD code or international dialing code for your work phone (for example 020 or +44).

Enter the local number for your work phone excluding the area code.

Enter another contact telephone number or other contact details you want us to use (for example an alternative phone, fax or messaging ID).

Enter your primary email address that we can use to contact you.

Enter your mobile/cell phone number, including the country or area code if applicable.

Enter the area/STD code or international dialing code for your home phone.

Enter the local number for your home phone excluding the area code.

Provide details of any counselling, mediation or family dispute resolution sessions you have attended with the person you are in dispute with, including dates, provider/organisation name, topics covered, outcomes, and whether any certificates were issued (attach copies if available). Fill only if 'Have you been to counselling/mediation or family dispute resolution sessions with the person you are in dispute with? — Yes' is 'Yes'.

Check this box if you have attended counselling, mediation, or family dispute resolution sessions with the person you are in dispute with (and attach any certificates received from these sessions).

Check this box if you have not attended any counselling, mediation, or family dispute resolution sessions with the person you are in dispute with.

Check this box if you do have to attend a court or tribunal.

Check this box if you do not have to go to any court or tribunal.

Enter the scheduled time of the court hearing. Fill only if 'Yes' is 'Yes'.

Enter the date of the court hearing if known. Fill only if 'Yes' is 'Yes'.

Enter the name and any relevant details of the tribunal you must attend (for example the tribunal type, registry or location and any case or reference number). Fill only if 'Tribunal — Give details' is selected.

Check this box if your matter is scheduled to be heard at the Drug Court.

Check this box if your matter is scheduled to be heard at the Mental Health Court.

Check this box if your matter is scheduled to be heard at the Supreme Court.

Check this box if your matter is scheduled to be heard at the Federal Circuit Court.

Check this box if your matter is scheduled to be heard at the Family Court of Australia.

Check this box if you do not know which court or tribunal you have to go to.

Check this box if your matter is scheduled to be heard at the District Court.

Check this box if your matter is before a tribunal and provide the tribunal name/details in the adjacent text box.

Check this box if your matter is scheduled to be heard at the Childrens Court.

Check this box if your matter is scheduled to be heard at the Court of Appeal.

Check this box if your matter is scheduled to be heard at the Magistrates Court.

Enter the name of the suburb or town where the court or tribunal hearing will take place. Fill only if 'Yes' is 'Yes'.

Enter a short title or one-line summary describing your criminal law problem (for example: 'assault charge', 'shoplifting', or 'bail hearing').

Check this box if you have a criminal record and will either attach a copy of your criminal record or list your criminal record (including matters where no conviction was recorded).

Check this box if you do have a criminal record and will either attach a copy or list your record below, including matters with no conviction recorded.

Check this box if you are unsure whether you have a criminal record and cannot confirm either yes or no.

Check this box if you do not have any criminal record to declare.

Briefly describe the offence or charge to be recorded for this entry. Fill only if 'Do you have a criminal record? — Yes', 'Do you have a criminal record? — Not sure' is 'Yes' or 'Not sure' (any).

Enter the penalty, outcome or sentence imposed for the offence (e.g., fine, community service, sentence details). Fill only if 'Do you have a criminal record? — Yes', 'Do you have a criminal record? — Not sure' is 'Yes' or 'Not sure' (any).

Enter the year when the listed offence occurred (four-digit or other year format). Fill only if 'Do you have a criminal record? — Yes', 'Do you have a criminal record? — Not sure' is 'Yes' or 'Not sure' (any).

Provide a short description or name of the offence for this record (for example, 'theft' or 'driving while disqualified'). Fill only if 'Do you have a criminal record? — Yes', 'Do you have a criminal record? — Not sure' is 'Yes' or 'Not sure' (any).

Enter the penalty, sentence or outcome imposed for this offence (for example, 'fine $200' or '12 months probation'). Fill only if 'Do you have a criminal record? — Yes', 'Do you have a criminal record? — Not sure' is 'Yes' or 'Not sure' (any).

Enter the year when the listed offence occurred (e.g., 2019). Fill only if 'Do you have a criminal record? — Yes', 'Do you have a criminal record? — Not sure' is 'Yes' or 'Not sure' (any).

Briefly describe the offence or charge for this entry (e.g., offence name or summary). Fill only if 'Do you have a criminal record? — Yes', 'Do you have a criminal record? — Not sure' is 'Yes' or 'Not sure' (any).

Provide the penalty imposed for this offence, such as fine amount, sentence, or other sanction. Fill only if 'Do you have a criminal record? — Yes', 'Do you have a criminal record? — Not sure' is 'Yes' or 'Not sure' (any).

Enter the year when the listed offence occurred (four-digit year). Fill only if 'Do you have a criminal record? — Yes', 'Do you have a criminal record? — Not sure' is 'Yes' or 'Not sure' (any).

Enter a brief description of the offence committed (name or type of the offence). Fill only if 'Do you have a criminal record? — Yes', 'Do you have a criminal record? — Not sure' is 'Yes' or 'Not sure' (any).

Enter the penalty, sanction or outcome imposed for the offence (for example fine, prison term, community service or other sentence). Fill only if 'Do you have a criminal record? — Yes', 'Do you have a criminal record? — Not sure' is 'Yes' or 'Not sure' (any).

Enter the year when the listed offence occurred (the calendar year). Fill only if 'Do you have a criminal record? — Yes', 'Do you have a criminal record? — Not sure' is 'Yes' or 'Not sure' (any).

Enter the date when you and the person in dispute separated or ended the de facto relationship. Fill only if 'Were you in a de facto relationship — Yes' is 'Yes'.

Enter the date when your de facto relationship with the person in dispute began. Fill only if 'Were you in a de facto relationship — Yes' is 'Yes'.

Check this box if you were NOT in a de facto relationship with the person you are in dispute with.

Check this box if you WERE in a de facto relationship with the person you are in dispute with.

Check this box if you need to provide details (dates and related information) about the de facto relationship; complete the Relationship date and Separation date fields below.

Enter a brief description of the physical disability that affects how you access services, including its nature, any limitations it causes and any aids, adjustments or assistance you need. Fill only if 'Yes', 'Physical' is 'Yes' and is 'Physical' (all).

Check this box if you do have a disability that affects how you access our services, then indicate the type(s) below.

Check this box if your disability affects your senses (including speech) and impacts how you access our services.

Check this box if your disability is psychological or psychiatric and affects how you access our services.

Check this box if your disability is physical and affects how you access our services (provide details if requested).

Check this box if you do not have a disability that affects how you access our services.

Check this box if your disability is intellectual in nature and affects how you access our services.

Check this box if you are responding to or defending against someone else’s application for a protection order. Fill only if 'Domestic/family violence' is 'Yes'.

Check this box if you are the person seeking to file a new protection order because of domestic or family violence. Fill only if 'Domestic/family violence' is 'Yes'.

Check this box if you are asking the court to change existing family court orders because of domestic or family violence concerns. Fill only if 'Domestic/family violence' is 'Yes'.

Enter the text of the email you will send with your application, including any message to the recipient and a clear list of the documents you are attaching.

Enter any extra information or comments relevant to your case or application that do not fit elsewhere on the form; be concise but include dates, names, locations or other facts needed to explain the matter.

Describe any extra or practical help you need to access services (for example help to read or write, mobility assistance, sight or hearing support), including what help is required and any relevant specifics. Fill only if 'Yes (Do you need extra or practical help?)' is 'Yes'.

Check this box if you do not need any extra or practical help to access services (for example, you do not need help to read or write).

Check this box if you do need extra or practical help to access services (for example, you need help to read or write).

Check this box when you have indicated 'Yes' and need to provide specific details about the extra or practical help you require.

Enter a brief summary describing your family or relationship problem, including key facts, people involved and the main issue you need help with.

Enter the fifth child's family/surname as it appears on official records. Fill only if 'Children under 18 — Yes' is 'Yes'.

Enter the fifth child's given name and any middle name(s). Fill only if 'Children under 18 — Yes' is 'Yes'.

State your relationship to the fifth child (for example: mother, father, guardian, foster parent). Fill only if 'Children under 18 — Yes' is 'Yes'.

Provide the name(s) or description of the person(s) or household the fifth child lives with. Fill only if 'Children under 18 — Yes' is 'Yes'.

Enter the fifth child's date of birth. Fill only if 'Children under 18 — Yes' is 'Yes'.

Indicate whether the fifth child is involved in this matter and give brief details of their involvement if applicable. Fill only if 'Children under 18 — Yes' is 'Yes'.

Enter the child's first name and any middle name(s). Fill only if 'Children under 18 — Yes' is 'Yes'.

Enter the child's family name (surname). Fill only if 'Children under 18 — Yes' is 'Yes'.

Enter your relationship to the child (for example: mother, father, guardian). Fill only if 'Children under 18 — Yes' is 'Yes'.

Enter the child's birth date. Fill only if 'Children under 18 — Yes' is 'Yes'.

Indicate whether the child is involved in this matter and provide brief details if applicable. Fill only if 'Children under 18 — Yes' is 'Yes'.

Provide the name(s) or relationship(s) of the person(s) the child currently lives with. Fill only if 'Children under 18 — Yes' is 'Yes'.

Check this box if the first person charged does have a lawyer; provide the lawyer's name and firm details in the fields below if known.

Check this box if the first person charged does not have a lawyer.

Check this box if you do not know whether the first person charged has a lawyer.

Enter the lawyer's full street address (including unit or suite if applicable) for the first person charged's legal representative. Fill only if 'Do they have a lawyer? — Yes (Give details below, if known)' is 'Yes'.

Enter the suburb or town where the lawyer's office is located. Fill only if 'Do they have a lawyer? — Yes (Give details below, if known)' is 'Yes'.

Enter the name of the law firm or organisation that represents the first person charged. Fill only if 'Do they have a lawyer? — Yes (Give details below, if known)' is 'Yes'.

Enter the lawyer's full name (given name and family name) who represents the first person charged. Fill only if 'Do they have a lawyer? — Yes (Give details below, if known)' is 'Yes'.

Enter the state or territory where the lawyer's practice is located. Fill only if 'Do they have a lawyer? — Yes (Give details below, if known)' is 'Yes'.

Enter the postcode for the lawyer's practice address. Fill only if 'Do they have a lawyer? — Yes (Give details below, if known)' is 'Yes'.

Enter the family (last) name of the first person charged. Fill only if 'Yes' is 'Yes'.

Enter any middle name(s) of the first person charged, or leave blank if none. Fill only if 'Yes' is 'Yes'.

Enter the given (first) name of the first person charged. Fill only if 'Yes' is 'Yes'.

Enter the street address (house/unit number and street name) for the first person charged. Fill only if 'Yes' is 'Yes'.

Enter the suburb or town of the first person charged's address. Fill only if 'Yes' is 'Yes'.

Enter the birth date of the first person charged. Fill only if 'Yes' is 'Yes'.

Enter the state or territory of the first person charged's address. Fill only if 'Yes' is 'Yes'.

Enter the postcode for the first person charged's address. Fill only if 'Yes' is 'Yes'.

Check this box if you are NOT completing the application for yourself and instead are acting for someone else (e.g., power of attorney, QCAT order, parent or guardian); you should then provide the authority details. Fill only if 'No — What authority do you have to complete this application for someone else?' is 'No'.

Check this box if you are completing the application for yourself; you must then read and sign the declaration below. Fill only if 'Yes — Read and sign declaration below' is 'Yes'.

Enter the fourth child’s family (last) name exactly as it should appear on records. Fill only if 'Children under 18 — Yes' is 'Yes'.

Enter the fourth child’s given name and any middle name(s). Fill only if 'Children under 18 — Yes' is 'Yes'.

Describe how the fourth child is related to you (for example: son, daughter, stepchild, foster child). Fill only if 'Children under 18 — Yes' is 'Yes'.

Provide the name(s) or description of the person(s) or household the fourth child normally lives with. Fill only if 'Children under 18 — Yes' is 'Yes'.

Enter the fourth child’s date of birth. Fill only if 'Children under 18 — Yes' is 'Yes'.

Indicate whether the fourth child is involved in this matter and, if relevant, give brief details of how they are involved. Fill only if 'Children under 18 — Yes' is 'Yes'.

If you selected 'Other' (or wish to add more detail), enter your gender identity or any relevant group/organisation details here as a short text description. Fill only if 'Other (give details)' is 'Other'.

Check this box if your gender is female.

Check this box if your gender is not male or female and provide the group or organisation or details in the adjacent field.

Check this box if your gender is male.

Check this box when you will post your completed form to GPO Box 2449 Brisbane Q 4001 or hand-deliver it to your nearest Legal Aid office (see back page for submission instructions).

Enter the state, province, or region for your home address.

Enter the postal code or ZIP code for your home address.

Enter the suburb, town, or city of your home address.

Enter the street address for your home, including house or unit number and street name.

Enter the household’s total gross income per week before tax in dollars, including all income sources (wages, benefits, pensions, child support, etc.).

Check this box if you have not yet decided how you will plead.

Check this box if you intend to plead guilty to the charges.

Check this box if you intend to plead not guilty to the charges.

Enter the language and specific dialect you need an interpreter for to help you complete this form (e.g., Spanish — Mexican, Arabic — Levantine). Fill only if 'Interpreter required — Yes' is 'Yes'.

Check this box if you do need an interpreter to help you fill out this form.

Check this box if you do not need an interpreter to help you fill out this form.

Enter the lawyer's full street or postal address, including unit/flat number, street number and name, and PO Box if applicable. Fill only if 'Yes' is 'Yes'.

Enter the name of the law firm or legal practice representing you. Fill only if 'Yes' is 'Yes'.

Enter the suburb or town for the lawyer's address. Fill only if 'Yes' is 'Yes'.

Enter the full name of your lawyer (given name and surname). Fill only if 'Yes' is 'Yes'.

Enter the postcode for the lawyer's address. Fill only if 'Yes' is 'Yes'.

Enter the state or territory for the lawyer's address (for example NSW, VIC, QLD). Fill only if 'Yes' is 'Yes'.

Check this box if you do not have a lawyer representing you for this matter.

Check this box if you do have a lawyer representing you for this matter.

Check this box if you have a lawyer and will provide their details (name, law firm, address) in the fields below.

Enter the number of the subsection that applies to your legal problem in this section (for example, the number that corresponds to 'Criminal law problem' or 'Family or relationship problem').

Enter the full contact details for this local Legal Aid Queensland office, including office name, street address, suburb/state/postcode, telephone number and email or website and any opening hours if relevant.

Enter the full contact details for this local Legal Aid Queensland office, including office name, street address, suburb/state/postcode, telephone number and email or website and any opening hours if relevant.

Enter the full contact details for this local Legal Aid Queensland office, including office name, street address, suburb/state/postcode, telephone number and email or website and any opening hours if relevant.

Enter the full contact details for this local Legal Aid Queensland office, including office name, street address, suburb/state/postcode, telephone number and email or website and any opening hours if relevant.

If you selected 'Other' for your marital status, enter a short description explaining your current marital situation (for example, 'living together', 'registered partnership', or other relevant detail). Fill only if 'Other' is 'Other'.

Check this box if you are legally divorced from a former spouse.

Check this box if you have never been married and are not in a de facto partnership.

Check this box if you are in a de facto (partner) relationship but are not legally married.

Check this box if you are legally married.

Check this box if you are separated from your spouse or de facto partner but are not legally divorced.

Check this box if your marital status is not listed among the options above.

Check this box if you will provide further details about your marital status in the adjacent text box.

Enter the date your divorce from the person you are in dispute with was finalized, if applicable. Fill only if 'Were you married to the person you are in dispute with? — Yes' is 'Yes'.

Enter the date you were married to the person you are in dispute with. Fill only if 'Were you married to the person you are in dispute with? — Yes' is 'Yes'.

Enter the date you and the person you are in dispute with separated. Fill only if 'Were you married to the person you are in dispute with? — Yes' is 'Yes'.

Provide any short, relevant details about the marriage or separation (for example, spouse name at time of marriage, place of marriage, or a brief explanatory note). Fill only if 'Were you married to the person you are in dispute with? — Yes' is 'Yes'.

Check this box if you WERE married to the person you are in dispute with.

Check this box if you were NOT married to the person you are in dispute with.

Check this box when you have answered Yes and need to provide marriage-related details (marriage date, separation date, divorce date) in the fields provided.

Enter your given first name (the name you are commonly known by) exactly as it should appear on official records.

Enter any middle name(s) you have; if you have none, leave this field blank.

Enter your family name or surname exactly as it appears on official documents.

If you selected 'Other' for your title, enter the specific title or details here (for example: Dr, Prof, Rev). Fill only if 'Title - Other' is 'Other'.

Check this box if your title is 'Miss'.

Check this box if your title is not listed and enter the specific title in the 'Give details' field.

Check this box if your title is 'Mrs'.

Check this box if your title is 'Ms'.

Check this box if your title is 'Mr'.

Enter a short description of what the next court date is for (for example: mention, committal, trial, sentence or other reason). Fill only if 'Next court date — Not sure' is 'No'.

Check this box if you do not know or cannot provide the date or purpose of your next court appearance.

Check this box if you are unsure whether your application is about a family or relationship problem and want to get legal advice.

Enter the total number of dependent children under 18 in your household (including children you pay child support or maintenance for).

Full name of the staff member who took the application and collected the applicant's initial information.

Full name of the staff member who entered the application details into the records or database.

Name of the staff member who advised that there is no in-house capacity for this matter.

Date when the application was taken.

Date when the application details were entered into the system.

Enter the full name of the staff member who took the application (include any job title or initials if required by your office).

Check this box when the required supporting documents have been attached to the application file.

Check this box when the staff member has visually confirmed and recorded that the applicant's health care or pension card has been sighted.

Enter the unique client identifier assigned by the office (alphanumeric code) for this application.

Enter the office file or reference number assigned to this case or application (include any letters or dashes used in your system).

Enter the date the application was taken or processed by office staff.

Check this box when recording the month (MM) of the application date in the Office Use Only date field.

Check this box when recording the year (YYYY) of the application date in the Office Use Only date field.

Check this box when recording the day (DD) of the application date in the Office Use Only date field.

Enter the name or internal identifier of the in-house lawyer to whom this matter is being assigned.

Check this box when the office has determined there is no available in-house capacity to take the matter.

Check this box when the matter should be assigned to an in-house lawyer for handling.

Provide a brief description of any other legal matters you are involved in (for example child protection or family law), including relevant dates, case numbers or parties if known. Fill only if 'Other legal matters — Yes' is 'Yes'.

Check this box if you are not involved in any other legal matters (for example, child protection or family law).

Check this box if you are unsure whether you are involved in any other legal matters.

Check this box if you are involved in one or more other legal matters.

Check this box to indicate you will provide details about the other legal matters in the adjacent text field (typically used after selecting Yes).

Enter the first or given name you have previously used (for example, a maiden name or former first name). Fill only if 'Yes' is 'Yes'.

Describe the kind of other name you used (for example, maiden name, previous married name, alias or stage name). Fill only if 'Yes' is 'Yes'.

Enter the family or surname you have previously used (for example, a maiden name or former surname). Fill only if 'Yes' is 'Yes'.

Check this box if you have used any other names (for example a maiden name, previous married name, or any alias).

Check this box if you have never used any other names (no maiden name, previous married name, or other aliases).

Check this box to indicate you will list your other names in the fields provided below.

Enter the health care or pension card number shown on the other person's card.

Enter the expiry date printed on the other person's health care or pension card.

Check this box if the other person holds a health care card (i.e., their card type is Health care).

Check this box if the other person holds a pension card (i.e., their card type is Pension).

Check this box when the family or relationship problem you are applying about is not listed among the options above, and provide details in the adjacent text field. Fill only if 'Q13 Yes' is 'Yes'.

Enter a short description of the 'Other' family or relationship problem that is not covered by the listed options. Fill only if 'Other' is 'Yes'.

Check this box if you have pleaded guilty in court to the charges.

Check this box if you have not pleaded guilty in court to the charges.

Check this box if the police have applied for a domestic and family violence protection order about this matter (and provide the day/month/year in the adjacent date fields). Fill only if 'Domestic/family violence' is 'Yes'.

Check this box if you do not know whether the police have applied for a domestic and family violence protection order about this matter. Fill only if 'Domestic/family violence' is 'Yes'.

Check this box if the police have not applied for a domestic and family violence protection order about this matter. Fill only if 'Domestic/family violence' is 'Yes'.

Enter the date when the police applied for a domestic and family violence protection order about this matter. Fill only if 'Yes — When?' is 'Yes'.

Enter the full street or PO box address for the contact/postal address, including unit or apartment number if applicable. Fill only if 'Home state/region', 'Home postcode/ZIP', 'Home suburb/town', 'Home address (street)' is different from the home address (any).

Enter the suburb or town for the contact/postal address. Fill only if 'Home state/region', 'Home postcode/ZIP', 'Home suburb/town', 'Home address (street)' is different from the home address (any).

Enter the postal code for the contact/postal address. Fill only if 'Home state/region', 'Home postcode/ZIP', 'Home suburb/town', 'Home address (street)' is different from the home address (any).

Enter the state or territory for the contact/postal address. Fill only if 'Home state/region', 'Home postcode/ZIP', 'Home suburb/town', 'Home address (street)' is different from the home address (any).

Enter the full name of the prison or detention centre where you are currently held. Fill only if 'Yes' is 'Yes'.

Enter the Integrated Offender Management System (IOMS) reference number assigned to you. Fill only if 'Yes' is 'Yes'.

Check this box if you are not currently in prison.

Check this box if you are currently in prison.

Check this box when you will provide the name of the prison or detention centre in the adjacent text field (use when 'Yes' applies).

Enter the date on which the person signed the declaration.

Enter the name or electronic signature of the person who has read, understood and accepted the Privacy and Conflict of Interest statement.

Check this box if the police HAVE taken any of your belongings under a proceeds of crime order; you should also attach a copy of the order.

Check this box if the police have NOT taken any of your belongings under a proceeds of crime order.

Check this box if your property settlement includes an item that is not listed among the other options (i.e., an ‘other’ item). Fill only if 'Property settlement' is 'Yes'.

Check this box if you are providing additional details about the 'Other' item and will complete the adjacent details box.

Enter a brief description of the ‘Other’ property or asset that is part of the settlement (for example type, make, location or any identifying details). Fill only if 'Other' is 'Yes'.

Check this box if recreation vehicles (for example boats or caravans) are part of your property settlement. Fill only if 'Property settlement' is 'Yes'.

Check this box if a motor vehicle is part of your property settlement. Fill only if 'Property settlement' is 'Yes'.

Check this box if savings are included as part of your property settlement. Fill only if 'Property settlement' is 'Yes'.

Check this box if the home you live in is included as part of your property settlement. Fill only if 'Property settlement' is 'Yes'.

Check this box if any other real estate (besides the home you live in) is part of your property settlement. Fill only if 'Property settlement' is 'Yes'.

Check this box if superannuation, insurance payments, or any other valuable items you can sell are part of your property settlement. Fill only if 'Property settlement' is 'Yes'.

Check this box if shares or bonds are included as part of your property settlement. Fill only if 'Property settlement' is 'Yes'.

Check this box if at least one application for a domestic and family violence protection order has already been lodged in court (and attach a copy of any application(s)). Fill only if 'Domestic/family violence' is 'Yes'.

Check this box if no application for a domestic and family violence protection order has been lodged in court. Fill only if 'Domestic/family violence' is 'Yes'.

Check this box if you are NOT applying for aid for a family or relationship problem (if checked, you should skip the family/relationship questions and follow the form instructions to go to question 17).

Check this box if you ARE applying for aid for a family or relationship problem and want to indicate which specific problem(s) apply.

Check this box to confirm you will skip the family/relationship section and proceed directly to question 17 (used when you are not applying for aid for a family/relationship problem).

Check this box if you are applying for or seeking spousal/partner maintenance (financial support from a former partner). Fill only if 'Q13 Yes' is 'Yes'.

Check this box if the issue involves child protection services or related processes (for example, family group meetings). Fill only if 'Q13 Yes' is 'Yes'.

Check this box if your application involves domestic or family violence (and provide details where requested). Fill only if 'Q13 Yes' is 'Yes'.

Check this box if you are unsure which type of family or relationship problem applies and you need legal advice. Fill only if 'Domestic/family violence' is 'Yes'.

Check this box if your application is about where your children live or custody/residence arrangements. Fill only if 'Q13 Yes' is 'Yes'.

Check this box if your matter concerns enforcement of an existing court order or reporting that a court order has been breached. Fill only if 'Q13 Yes' is 'Yes'.

Check this box if your matter involves child support payments, maintenance or paternity issues. Fill only if 'Q13 Yes' is 'Yes'.

Check this box if your application concerns dividing property, assets or other settlement items between parties. Fill only if 'Q13 Yes' is 'Yes'.

Check this box if your issue is about time, visitation or contact arrangements for your children. Fill only if 'Q13 Yes' is 'Yes'.

Check this box if your application relates to divorce proceedings. Fill only if 'Q13 Yes' is 'Yes'.

Check this box if your application concerns parental decision-making about your children’s upbringing (schooling, health, religion, etc.). Fill only if 'Q13 Yes' is 'Yes'.

Check this box if you currently have one or more court orders about this family matter (for example domestic violence protection orders, child protection orders, family law orders); attach a copy of any order(s).

Check this box if you do not currently have any court orders about this family matter.

Check this box if they do not have a lawyer.

Check this box if you do not know whether they have a lawyer.

Check this box if they do have a lawyer.

Check this box if you can provide the lawyer's name and contact details in the fields below.

Enter the lawyer's full name (given name and family name) for the person representing this matter, if known. Fill only if 'Yes' is 'Yes'.

Enter the name of the law firm or legal practice the lawyer works for, if known. Fill only if 'Yes' is 'Yes'.

Enter the lawyer's street address, including unit or building number, street name and any PO Box information, if known. Fill only if 'Yes' is 'Yes'.

Enter the suburb or town for the lawyer's address. Fill only if 'Yes' is 'Yes'.

Enter the postcode for the lawyer's address. Fill only if 'Yes' is 'Yes'.

Enter the state or territory for the lawyer's address (abbreviation or full name). Fill only if 'Yes' is 'Yes'.

Enter the person's primary phone number, including area or country code if relevant.

Enter the person's email address.

Enter the person's given or first name.

Enter the person's street address, including house or unit number and street name.

Describe your relationship to the person (for example: partner, ex-partner, parent, friend, flatmate).

Enter any middle name(s) the person has, or leave blank if they have none.

Enter the person's date of birth.

Enter the postcode for the person's address.

Enter the family name (surname) of the person you have the legal issue with.

Enter the suburb, town or city where the person lives.

Enter the state or territory where the person lives (for example NSW, VIC, QLD).

Describe your current living arrangements here (for example, moved in with a relative, moved to a nursing home, moved to a lower-cost house), providing any relevant dates or context. Fill only if 'Q7a Yes' is 'Yes'.

Enter the amount of weekly income you receive from the property you moved out of (for example rent received from that property).

Describe the disability or health problem that caused you to move or buy another home, including relevant details such as how it affected your living situation and any dates or circumstances of the move. Fill only if 'Q7a Yes' is 'Yes'.

Check this box if the applicant (if 60 years or older) has had to move out of the home or buy another home because of a disability or health problem.

Check this box if, and only if, the applicant (if 60 years or older) has not had to move out of the home or buy another home because of a disability or health problem.

Check this box when you will provide details about the disability or health problem in the space provided (use this when 'Yes' applies).

State how long you have lived in the home (for example, number of years and months, if applicable). Fill only if 'Q7a Yes — the home you live in' is 'Yes'.

Provide the date you purchased the home. Fill only if 'Q7a Yes — the home you live in' is 'Yes'.

Enter the current market value of the home you live in. Fill only if 'Q7a Yes — the home you live in' is 'Yes'.

Enter the amount of equity you (or the person who helps you financially) have in this property. Fill only if 'Q7a Yes — the home you live in' is 'Yes'.

Enter the total outstanding mortgage or loan balance secured on this home. Fill only if 'Q7a Yes — the home you live in' is 'Yes'.

Check this box if you (or the person who helps you financially) DO own or are paying off the home you currently live in.

Check this box if you (or the person who helps you financially) do NOT own or are NOT paying off the home you currently live in.

Enter how much equity you have in this other real estate (the portion of the property's value that you own after subtracting any mortgage). Fill only if 'b) any other real estate apart from the home you live in? — Yes' is 'Yes'.

Enter the total outstanding mortgage or loan balance secured against this other real estate. Fill only if 'b) any other real estate apart from the home you live in? — Yes' is 'Yes'.

Enter the current market value of the other real estate you own (not the home you live in). Fill only if 'b) any other real estate apart from the home you live in? — Yes' is 'Yes'.

Check this box if you (or the person who helps you financially) DO own other real estate (for example, a house or land) besides the home you live in and you will provide details.

Check this box if you (or the person who helps you financially) do NOT own any other real estate apart from the home you live in.

Check this box when you are providing the value, mortgage and equity details for any other real estate you (or the person who helps you financially) own.

Enter the current amount of equity you have in the vehicle. Fill only if 'Q7c - Yes (a motor vehicle(s)?)' is 'Yes'.

Check this box if you or the person who helps you financially do not own any motor vehicle(s).

Check this box if you or the person who helps you financially do own one or more motor vehicle(s).

Check this box when you have answered Yes and need to provide details about the vehicle(s), such as how much equity you have in them and any other requested information.

Enter the total amount of money currently held in the bank account(s) of the applicant (or the person who helps them financially). Fill only if 'Q8 — Yes' is 'Yes'.

Check this box if you or a person who helps you financially do NOT have any money in the bank.

Check this box if you or a person who helps you financially DO have money in the bank.

Check this box when you are providing the bank account and amount details for the money in the bank (use when 'Yes' applies and you will enter the amount and bank account information).

Provide a brief description of the other valuable items (for example: type of item, make/model, and any identifying details) that you can sell or use now. Fill only if 'Q9 Other — Other (Give details)' is 'Yes'.

Enter the total dollar value of other valuable items you (or the person who helps you financially) can sell or use now.

Check this box if you or a person who helps you financially have any other valuable items (not listed above) that you can sell or use now, and you will provide details in the space provided.

Enter the total amount (in dollars) of superannuation you can access now, insurance payouts or any other valuable items you can sell or convert to cash.

Enter the total current value (amount in dollars) of recreation vehicles such as boats, caravans or similar items you can sell or use now.

Enter the total current value (amount in dollars) of any shares or bonds you or the person who helps you financially can sell or access now.

Check this box if you have not been charged with any offence; if checked, follow the form instruction to go to question 13.

Check this box if you have been charged with one or more offences, and then list the details of each charge in the table provided.

Check this box if you are not applying for aid for a civil law problem (answer is No) — if checked, proceed to question 18.

Check this box if you are applying for aid for a civil law problem (answer is Yes) — if checked, specify which type of civil law problem below.

Check this box if your civil law problem relates to an inquest. Fill only if 'Question 17 - Yes' is 'Yes'.

Check this box if your civil law problem is an anti-discrimination matter. Fill only if 'Question 17 - Yes' is 'Yes'.

Check this box if your civil law problem concerns mental health matters. Fill only if 'Question 17 - Yes' is 'Yes'.

Check this box if your civil law problem concerns dangerous prisoners. Fill only if 'Question 17 - Yes' is 'Yes'.

Check this box if your civil law problem is about child protection, then go to question 13 on page 9. Fill only if 'Question 17 - Yes' is 'Yes'.

Check this box if your civil law problem relates to migration or immigration matters. Fill only if 'Question 17 - Yes' is 'Yes'.

Check this box if your civil law problem involves domestic or family violence, then go to question 13 on page 9. Fill only if 'Question 17 - Yes' is 'Yes'.

Check this box if your civil law problem is about peace and good behaviour. Fill only if 'Question 17 - Yes' is 'Yes'.

Check this box if your civil law problem involves workers’ compensation. Fill only if 'Question 17 - Yes' is 'Yes'.

Check this box if your civil law problem is a veteran’s appeal (war caused) or another defence appeal. Fill only if 'Question 17 - Yes' is 'Yes'.

Check this box if you are not sure which problem type applies and you need to get legal advice. Fill only if 'Question 17 - Yes' is 'Yes'.

Check this box if your civil law problem concerns an Administrative Appeals Tribunal matter. Fill only if 'Question 17 - Yes' is 'Yes'.

Check this box if your civil law problem is not listed here and provide more details under question 18. Fill only if 'Question 17 - Yes' is 'Yes'.

Enter the specific civil law problem if your situation is not listed above (briefly describe the issue or give the problem name).

Enter the first portion of your answer to Question 18: briefly describe what the legal problem is and who is involved.

Provide financial details relevant to your situation, especially if you do not receive any income or have financial hardship related to this matter.

Use this field to add context or supporting facts about the dispute, including references to documents or evidence where relevant.

Enter the next portion of your legal problem description, explaining how and when the problem started.

Describe any special circumstances or vulnerabilities that apply to your situation, such as health, caring responsibilities, vulnerability or urgency.

Provide further details about what has happened since the problem started, including key events and developments.

Enter any additional relevant information not yet covered, such as related parties, prior legal steps taken or outcomes.

Add more narrative about actions taken, responses from other parties, and any ongoing issues relevant to the legal problem.

Provide a brief concluding summary of your legal problem and state what outcome or assistance you are seeking.

Continue your explanation with names, dates, locations and specific incidents that help explain the legal problem.

If you need more space, continue your narrative here and include any final remarks or clarifications relevant to Question 18.

Check this box when you need to indicate that there are additional details to provide for question 18 (i.e., you will list extra information about the matter at question 18).

Check this box if you do get financial help from another person (for example a relative or partner) who regularly gives you money, helps pay your bills, or shares living expenses.

Check this box if you do not get financial help from another person and no one regularly gives you money, helps pay your bills, or shares your living expenses.

Enter the details of the self‑employment, small business or farming activity (for example business name, your role, nature of the work and any relevant contact or identifying information) to explain the self‑employment situation. Fill only if 'Question 4 - Yes (self‑employed/small business owner/farmer)' is 'Yes'.

Check this box if neither you nor anyone who financially helps you is self‑employed, a small business owner, or a farmer.

Check this box if you or someone who financially helps you is self‑employed, a small business owner, or a farmer.

Check this box to indicate you will give full details and attach supporting information about the self‑employment or business/farming activities.

Check this box if you, or the person who helps you financially, do receive a Centrelink or Veterans’ Affairs payment (this will prompt you to indicate which payment).

Check this box if you, or the person who helps you financially, do not receive any Centrelink or Veterans’ Affairs payment.

Enter the name or brief details of any other Centrelink or Veterans’ Affairs payment received that is not listed in the options above. Fill only if 'Question 5 - Other payment' is 'Yes'.

Check this box if you (or the person who helps you financially) receive Youth Allowance. Fill only if 'Question 5 - Yes' is 'Yes'.

Check this box if you (or the person who helps you financially) receive a Disability Support Pension. Fill only if 'Question 5 - Yes' is 'Yes'.

Check this box if you (or the person who helps you financially) receive Parenting Payment (partnered). Fill only if 'Question 5 - Yes' is 'Yes'.

Check this box if you (or the person who helps you financially) receive Newstart Allowance. Fill only if 'Question 5 - Yes' is 'Yes'.

Check this box if you (or the person who helps you financially) receive a Veterans' or war‑services payment. Fill only if 'Question 5 - Yes' is 'Yes'.

Check this box if you (or the person who helps you financially) receive Sickness Allowance. Fill only if 'Question 5 - Yes' is 'Yes'.

Check this box if you (or the person who helps you financially) receive Widow Allowance. Fill only if 'Question 5 - Yes' is 'Yes'.

Check this box if the Centrelink/Veterans' payment is being received at the full rate. Fill only if 'Question 5 - Yes' is 'Yes'.

Check this box if you (or the person who helps you financially) receive a Mature Age Allowance or pension‑type benefit. Fill only if 'Question 5 - Yes' is 'Yes'.

Check this box if you (or the person who helps you financially) receive a Special Benefit payment. Fill only if 'Question 5 - Yes' is 'Yes'.

Check this box if you (or the person who helps you financially) receive a Centrelink/Veterans' payment not listed above; provide details in the 'Give details' field. Fill only if 'Question 5 - Yes' is 'Yes'.

Check this box if you (or the person who helps you financially) receive Single Parenting Payment. Fill only if 'Question 5 - Yes' is 'Yes'.

Check this box if the Centrelink/Veterans' payment is being received at a part rate (not full). Fill only if 'Question 5 - Yes' is 'Yes'.

Check this box if you will provide or attach further details about the payment selected (use the adjacent text field or attachment area).

Check this box if you are single (not living as a couple) and you are currently employed.

Check this box if you are single (not living as a couple) and you are not currently working.

Check this box if you live as a couple and both partners are currently employed.

Check this box if you live as a couple and neither partner is currently working.

Check this box if you live as a couple and only one person in the couple is currently employed.

Check this box if you are or were in an intimate personal relationship (for example, dating or sexual partner) with the other person. Fill only if 'Domestic/family violence' is 'Yes'.

Check this box if the other person is a relative or member of your extended family. Fill only if 'Domestic/family violence' is 'Yes'.

Check this box if the situation involves an informal carer/carer relationship with the other person. Fill only if 'Domestic/family violence' is 'Yes'.

Check this box if the other person is your spouse or de facto partner. Fill only if 'Domestic/family violence' is 'Yes'.

Check this box if none of the listed relationship types apply to the situation. Fill only if 'Domestic/family violence' is 'Yes'.

Enter the second child's first name and any middle name(s). Fill only if 'Children under 18 — Yes' is 'Yes'.

Enter the second child's family name (surname) as it appears on official records. Fill only if 'Children under 18 — Yes' is 'Yes'.

Describe how the second child is related to you (for example: son, daughter, stepchild, foster child). Fill only if 'Children under 18 — Yes' is 'Yes'.

Provide the name(s) or brief description of the person(s) the second child normally lives with (for example: 'mother and father', 'grandparents'). Fill only if 'Children under 18 — Yes' is 'Yes'.

Enter the second child's date of birth. Fill only if 'Children under 18 — Yes' is 'Yes'.

State whether the second child is involved in this matter and include brief details if relevant. Fill only if 'Children under 18 — Yes' is 'Yes'.

Enter the lawyer's street address for the second person charged, including unit or street number and street name. Fill only if 'Do they have a lawyer? — Yes' is 'Yes'.

Enter the full name of the law firm representing the second person charged. Fill only if 'Do they have a lawyer? — Yes' is 'Yes'.

Enter the full name of the lawyer representing the second person charged. Fill only if 'Do they have a lawyer? — Yes' is 'Yes'.

Enter the suburb or town for the lawyer's address for the second person charged. Fill only if 'Do they have a lawyer? — Yes' is 'Yes'.

Enter the postcode (postal code) for the lawyer's address for the second person charged. Fill only if 'Do they have a lawyer? — Yes' is 'Yes'.

Enter the state or territory for the lawyer's address for the second person charged. Fill only if 'Do they have a lawyer? — Yes' is 'Yes'.

Check this box if the second person charged does have a lawyer and you will provide the lawyer's details below if known.

Check this box if you do not know whether the second person charged has a lawyer.

Check this box if the second person charged does not have a lawyer.

Enter the second person's full street address, including unit or apartment number if applicable.

Enter the second person's middle name or any additional given names (leave blank if none).

Enter the second person's first/given name as it appears on official documents.

Enter the second person's family/surname as it appears on official documents.

Enter the suburb or town of the second person's usual residence.

Enter the second person's date of birth.

Enter the state or territory of the second person's usual residence.

Enter the postcode for the second person's address.

Check this box if you do have special circumstances and you will provide the details at question 18.

Check this box if you do not have any special circumstances (for example long‑standing ill health, difficulty reading or writing, inability to access assets or work).

Enter the third child's given name and any middle name(s). Fill only if 'Children under 18 — Yes' is 'Yes'.

Enter the third child's surname or family name. Fill only if 'Children under 18 — Yes' is 'Yes'.

State how the third child is related to you (for example: son, daughter, stepchild, foster child). Fill only if 'Children under 18 — Yes' is 'Yes'.

Enter the third child's date of birth. Fill only if 'Children under 18 — Yes' is 'Yes'.

Provide the name(s) or description of the person(s) the third child normally lives with (for example: mother, father, both parents, guardian). Fill only if 'Children under 18 — Yes' is 'Yes'.

Indicate whether the third child is involved in this matter and give brief details if applicable (for example: 'Yes – attending hearing' or 'No'). Fill only if 'Children under 18 — Yes' is 'Yes'.

Enter the main header or title text that appears in the top highlighted banner of the form (e.g., document title, section header, or organisation name).

Check this box if you do not know whether anyone else was charged with you.

Check this box if someone else was charged with you; you should then provide the other person’s details below.

Check this box if no one else was charged with you — if selected, you should go to question 12.

Check this box when you are able to give details about the other person(s) charged (fill in the name fields below). Fill only if 'Yes' is 'Yes'.

Enter the full number printed on your health care or pension card for yourself.

Enter the expiry date shown on your health care or pension card for yourself.

Enter any reference, section number or short note associated with the current health care/pension card details section as shown on the form.

Check this box when the card number/expiry you are entering is a Health Care card.

Check this box when the card number/expiry you are entering is a Pension card.