Legal Aid Queensland application form (LAQAPP) Instructions

Check this box if you identify as Torres Strait Islander (if you also identify as Aboriginal, tick that box as well).

Check this box if you identify as Aboriginal (if you also identify as Torres Strait Islander, tick that box as well).

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

Provide a full description of any extra information about your family or relationship problem (for example names, dates, circumstances, events, actions taken and any other relevant details) that does not fit elsewhere on the form.

Enter the applicant's declaration text — for example the printed name, signature or written statement confirming that the information provided on this form is true and correct.

Enter the applicant's given (first) name exactly as it appears on official documents.

Enter any middle names or initials the applicant uses, separating multiple names with spaces or commas.

Enter the applicant's family name or surname exactly as it appears on official documents.

If 'Other' was chosen for Title, enter the specific title (for example, Dr or Prof); otherwise leave this field blank. Fill only if 'Other' is selected.

Check this box if the applicant's title is Miss.

Check this box if the applicant's title is not listed and provide the specific title in the 'Give details' field.

Check this box if the applicant's title is Mrs.

Check this box if the applicant's title is Ms.

Check this box if the applicant's title is Mr.

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

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

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

Enter the date when the applicant or authorised person signed the consent.

Enter the full name of the person giving consent and authorising Police Prosecutions to release information to Legal Aid Queensland.

Provide the signature of the applicant or the authorised person who is consenting to the release of information.

Check this box if you do NOT consent to Police Prosecutions providing Legal Aid Queensland with a copy of your Queensland Police Service court brief and/or your criminal and traffic history.

Check this box if you DO consent to Police Prosecutions providing Legal Aid Queensland with a copy of your Queensland Police Service court brief and/or your criminal and traffic history.

Check this box if the police HAVE taken any of your belongings under a proceeds of crime order; if you have the order, attach a copy as requested on the form.

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

Enter the day component of your birth date.

Enter the name of the country where you were born if you answered Yes to 'Were you born in another country?'; provide the full country name (e.g., "India", "United Kingdom"). Fill only if 'Born in another country — Yes' is 'Yes'.

Check this box if you were born in a country other than the one this form is for (i.e., you were born in another country).

Check this box if you were not born in another country (i.e., you were born in the country this form is for).

Enter the name or brief description of the offence or charge for the fifth listed entry. Fill only if 'Question 11 - Yes (List your charges)' is 'Yes'.

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

Provide a brief description or name of the first charge or offence being listed (e.g., offence type or statute). Fill only if 'Question 11 - Yes (List your charges)' is 'Yes'.

Enter the date when the first listed charge was laid or the person was charged. Fill only if 'Question 11 - Yes (List your charges)' is 'Yes'.

Enter the name(s) or brief description of the charge(s) for the fourth listed offence. Fill only if 'Question 11 - Yes (List your charges)' is 'Yes'.

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

Enter the date when the second listed charge was filed or laid against you. Fill only if 'Question 11 - Yes (List your charges)' is 'Yes'.

Provide the full name or description of the second offence or charge you are listing. Fill only if 'Question 11 - Yes (List your charges)' is 'Yes'.

Enter the date when the third charge was laid or you were charged. Fill only if 'Question 11 - Yes (List your charges)' is 'Yes'.

Provide the full name or short description of the third offence or charge you are listing. Fill only if 'Question 11 - Yes (List your charges)' is 'Yes'.

Check this box if you have attached photocopies of any court documents you have received or filed relevant to this application.

Check this box if you have attached the Queensland Police Service Court Brief (QP9) and any related criminal/traffic history, notice to appear, or proceeds of crime order for the criminal law problem.

Check this box if you are attaching any court orders, family dispute resolution certificate(s), or an invitation to attend a family dispute resolution conference as evidence for a family or relationship problem.

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

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

Check this box if you are attaching a Centrelink income statement with your application.

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

Check this box if you are attaching copies of bank statements for the past three months from all financial institutions where you have accounts.

Check this box if you are attaching documentation that verifies your self‑employed income.

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 provide their details in the table provided.

Enter the identifier or number for this civil law problem section as shown on the form (for example, '1').

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

Enter the family (last) name or surname of the person who made the complaint against you. Fill only if 'Complainant — 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 if you are not completing the application for yourself and must provide the authority (e.g., power of attorney, QCAT order, parent, guardian) to act on the other person's behalf.

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

Enter the area or STD code for your work phone in the left-hand box.

Enter the main part of your work phone number in the right-hand box (the rest of the number, excluding the area code).

Enter any additional contact detail (for example an alternative phone number or secondary email).

Enter your primary email address for contact.

Enter your mobile (cell) phone number for contact.

Enter the area or STD code for your home phone in the left-hand box.

Enter the main part of your home phone number in the right-hand box (the rest of the number, excluding the area code).

Describe any counselling, mediation or family dispute resolution sessions you have attended with the person you are in dispute with, including dates, provider/organisation names, number of sessions, key outcomes and any certificates referenced or attached. Fill only if 'Counselling/mediation sessions — 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 copies of any certificates received from those sessions).

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

Enter the name and any relevant details about the tribunal (for example the tribunal division, case reference or brief description) you must attend. Fill only if 'Tribunal ► Give details' is 'Yes'.

Enter the suburb or town where the court or tribunal hearing will take place. Fill only if 'Do you have to go to court or a tribunal? — Yes' is 'Yes'.

Check this box if you have to attend or the matter is being heard in the Drug Court. Fill only if 'Do you have to go to court or a tribunal? — Yes' is 'Yes'.

Check this box if you have to attend or the matter is being heard in the Mental Health Court. Fill only if 'Do you have to go to court or a tribunal? — Yes' is 'Yes'.

Check this box if you have to attend or the matter is being heard in the Supreme Court. Fill only if 'Do you have to go to court or a tribunal? — Yes' is 'Yes'.

Check this box if you have to attend or the matter is being heard in the Federal Circuit Court. Fill only if 'Do you have to go to court or a tribunal? — Yes' is 'Yes'.

Check this box if you have to attend or the matter is being heard in the Family Court of Australia. Fill only if 'Do you have to go to court or a tribunal? — Yes' is 'Yes'.

Check this box if you do not know which court or tribunal applies to your matter. Fill only if 'Do you have to go to court or a tribunal? — Yes' is 'Yes'.

Check this box if you have to attend or the matter is being heard in the District Court. Fill only if 'Do you have to go to court or a tribunal? — Yes' is 'Yes'.

Check this box if the matter is before a tribunal, and provide the tribunal details in the adjacent 'Give details' field. Fill only if 'Do you have to go to court or a tribunal? — Yes' is 'Yes'.

Check this box if you have to attend or the matter is being heard in the Childrens Court. Fill only if 'Do you have to go to court or a tribunal? — Yes' is 'Yes'.

Check this box if you have to attend or the matter is being heard in the Court of Appeal. Fill only if 'Do you have to go to court or a tribunal? — Yes' is 'Yes'.

Check this box if you have to attend or the matter is being heard in the Magistrates Court. Fill only if 'Do you have to go to court or a tribunal? — Yes' is 'Yes'.

Enter the time of the court or tribunal appearance if known. Fill only if 'Do you have to go to court or a tribunal? — Yes' is 'Yes'.

Enter the date of the court or tribunal appearance if known. Fill only if 'Do you have to go to court or a tribunal? — Yes' is 'Yes'.

Check this box if you must attend a court or tribunal proceeding related to this matter.

Check this box if you do not have to attend any court or tribunal for this matter.

Enter a short, plain-language summary of your criminal law issue (for example what happened, the alleged offence or charge, and the main concern you need help with).

Check this box if the person does have a criminal record; if checked, attach a copy or list the record in the space provided.

Check this box if the person is unsure whether they have a criminal record.

Check this box if the person does not have a criminal record.

Check this box to indicate you are attaching a copy of the criminal record or listing the criminal record (including matters where no conviction was recorded).

Enter a brief description or name of the offence to be recorded in the first row.

Enter the penalty, sentence or outcome associated with the offence listed in the first row.

Enter the year when the listed offence occurred for the first criminal-record row.

Describe the offence or charge (brief title or description) for the fourth row of the criminal record table.

Provide the penalty, sentence or outcome (e.g., fine amount, imprisonment, conviction details) associated with the offence in the fourth row.

Enter the year when the offence occurred (four-digit year) for the fourth row of the criminal record table.

Describe the offence or charge for the second-row entry as it appears on your criminal record.

Provide the penalty, sentence or outcome associated with the second-row offence (for example fines, imprisonment, community orders or other outcomes).

Enter the year of the offence listed on the second row of the criminal record table.

Briefly describe the offence or charge for this entry (e.g., 'shoplifting' or the specific statutory offence).

Enter the penalty or outcome for this offence, such as the sentence, fine, discharge or other disposition.

Enter the year when the listed criminal matter occurred (e.g., 2018).

Enter the date when your de facto relationship with the person in dispute ended or when you separated. Fill only if 'Yes' is 'Yes'.

Enter the date when your de facto relationship with the person in dispute began. Fill only if '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 when you need to provide details about the de facto relationship (for example relationship date and separation date) after selecting Yes.

Enter a clear description of your disability or access needs, including the type of disability, how it affects your ability to use services, and any specific assistance or accommodations required. Fill only if 'Do you have a disability - Yes', 'Physical' is 'Yes' and is 'Yes' (all).

Check this box if you have a disability that affects how you access services.

Check this box if you have a sensory impairment (including speech) that affects how you access services. Fill only if 'Do you have a disability - Yes' is 'Yes'.

Check this box if you have a psychological or psychiatric condition that affects how you access services. Fill only if 'Do you have a disability - Yes' is 'Yes'.

Check this box if you have a physical disability that affects how you access services (and provide details in the adjoining field). Fill only if 'Do you have a disability - Yes' is 'Yes'.

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

Check this box if you have an intellectual disability that affects how you access services. Fill only if 'Do you have a disability - Yes' is 'Yes'.

Check this box if you are responding to (the respondent in) an existing protection order application. Fill only if 'Domestic/family violence' is 'Yes'.

Check this box if you are the applicant who is filing or applying for a protection order. Fill only if 'Domestic/family violence' is 'Yes'.

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

Enter the recipient email address where you will send your application (e.g., the Legal Aid Queensland email) as a single string.

Enter any additional details about your legal problem(s) for this section, providing relevant facts, dates, locations and explanations that help describe your situation.

Enter a brief description of any extra or practical help you need to access services (for example, help to read, write, or complete forms). Fill only if 'Yes' is 'Yes'.

Check this box if you do not need any extra or practical help to access the service.

Check this box if you do need extra or practical help to access the service.

Check this box (or use the adjacent space) when you have selected Yes and need to provide specific details about the extra or practical help required.

Briefly describe the family or relationship legal problem you need help with, including key facts or issues (for example: separation, child arrangements, domestic violence, property disputes).

Enter the family (last) name of your fifth child. Fill only if 'Yes' is 'Yes'.

Enter the first name and any middle names of your fifth child. Fill only if 'Yes' is 'Yes'.

State the relationship of your fifth child to you (for example: son, daughter, stepchild or foster child). Fill only if 'Yes' is 'Yes'.

Specify who the fifth child currently lives with (for example: both parents, mother only, father only, guardian). Fill only if 'Yes' is 'Yes'.

Enter the birth date of your fifth child. Fill only if 'Yes' is 'Yes'.

Indicate whether the fifth child is involved in this matter and provide brief details if relevant. Fill only if 'Yes' is 'Yes'.

Enter the child's given and middle name(s) exactly as they should appear on official records. Fill only if 'Yes' is 'Yes'.

Enter the child's family or surname as it appears on official records. Fill only if 'Yes' is 'Yes'.

Enter how this child is related to you (for example: son, daughter, stepchild, foster child). Fill only if 'Yes' is 'Yes'.

Enter the child's date of birth. Fill only if 'Yes' is 'Yes'.

Indicate whether and how this child is involved in the matter (for example: Yes, No, or a brief explanation). Fill only if 'Yes' is 'Yes'.

Enter the name(s) or relationship(s) of the person(s) the child currently lives with (for example: mother, father, grandparent, guardian). Fill only if 'Yes' is 'Yes'.

Enter the lawyer's street address (including unit, suite or PO Box if applicable). Fill only if 'First person charged – Lawyer: Yes' is 'Yes'.

Enter the suburb or town for the lawyer's address. Fill only if 'First person charged – Lawyer: Yes' is 'Yes'.

Enter the name of the lawyer's law firm or legal practice. Fill only if 'First person charged – Lawyer: Yes' is 'Yes'.

Enter the lawyer's full name (family and given names) for the first person charged. Fill only if 'First person charged – Lawyer: Yes' is 'Yes'.

Enter the state or territory for the lawyer's address. Fill only if 'First person charged – Lawyer: Yes' is 'Yes'.

Enter the postcode for the lawyer's address. Fill only if 'First person charged – Lawyer: Yes' is 'Yes'.

Check this box if you know the first person charged has a lawyer and you will provide the lawyer’s details below.

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

Check this box if you are unsure whether the first person charged has a lawyer.

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

Enter the full street address (street number, street name and unit or apartment if applicable) for the first person charged. Fill only if 'Yes' is 'Yes'.

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

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

Enter the state or territory for 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'.

Enter the fourth child's family (last) name or surname. Fill only if 'Yes' is 'Yes'.

Enter the fourth child's first name and any middle name(s) as they appear on official records. Fill only if 'Yes' is 'Yes'.

State how the fourth child is related to you (for example, 'son', 'daughter', 'stepchild'). Fill only if 'Yes' is 'Yes'.

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

Enter the fourth child's birth date. Fill only if 'Yes' is 'Yes'.

Indicate whether the fourth child is involved in this matter, for example 'Yes', 'No', or a brief explanation of involvement. Fill only if 'Yes' is 'Yes'.

Enter the gender identity or further details about your gender (for example a non-binary identity, gender group, or organisation) as a short descriptive text. Fill only if 'Other' is selected.

Check this box if your gender is female.

Check this box if your gender is not male or female, and provide details in the 'Give details' field next to this option.

Check this box if your gender is male.

Enter the phone number to contact the grants enquiries office (include area code and any parentheses or spacing as needed).

Enter the current health care or pension card information for this person — a short summary such as card type and identifying details (for example cardholder name, card reference or brief note) so the card can be identified.

Enter the health care or pension card number that belongs to the other person (as shown on their card).

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

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

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

Enter the full number shown on your health care or pension card as it appears on the card.

Enter the expiry date printed on your health care or pension card.

Check this box if the card held by you is a Health care card (select when your card type is Health care).

Check this box if the card held by you is a Pension card (select when your card type is Pension).

Enter the state, province or territory for your home address (abbreviation or full name).

Enter the postcode or ZIP code for your home address.

Enter the suburb, town or city where your home is located.

Enter your full street address for your home, including house/unit number and street name.

Check this box if you are unsure how you wish to plead at this time.

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

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

Enter the language and specific dialect you need an interpreter for (for example, Spanish — Mexican or Arabic — Levantine). Fill only if 'Interpreter required - Yes' is 'Yes'.

Check this box if you need an interpreter to help you fill out this form (and then provide the language and dialect).

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

Enter the lawyer's street address, including unit or street number and street name. Fill only if 'Yes' is 'Yes'.

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

Enter the suburb or town where the lawyer's office is located. Fill only if 'Yes' is 'Yes'.

Enter the full name of the lawyer who is representing you. Fill only if 'Yes' is 'Yes'.

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

Enter the state or territory where the lawyer's office is located. Fill only if 'Yes' is 'Yes'.

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

Check this box if you have a lawyer representing you.

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

Enter the section or subsection number that shows which part of 'Your legal problem' applies to your situation (for example: 1).

Enter the local Legal Aid Queensland office’s full name and contact details for this box, including street address (suburb/state/postcode), main phone number and email if available.

Enter the local Legal Aid Queensland office’s full name and contact details for this box, including street address (suburb/state/postcode), main phone number and email if available.

Enter the local Legal Aid Queensland office’s full name and contact details for this box, including street address (suburb/state/postcode), main phone number and email if available.

Enter the local Legal Aid Queensland office’s full name and contact details for this box, including street address (suburb/state/postcode), main phone number and email if available.

Enter a brief description specifying your marital status if it is not listed (fill in details when you select 'Other'). Fill only if 'Other' is selected.

Check this box if you are divorced.

Check this box if you are not married and not in a de facto relationship.

Check this box if you are in a de facto (unmarried partnership) relationship.

Check this box if your current marital status is Married.

Check this box if you are separated from your spouse or de facto partner.

Check this box if your marital status is not listed here and you need to specify a different status.

Check this box to indicate you will provide details about your 'Other' marital status in the adjacent text field.

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

Enter the town, city or location where you and the person in dispute were married. 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 will provide further details (for example marriage, separation, or divorce dates) about the marriage to the person you are in dispute with.

Check this box to indicate you will post your completed form to GPO Box 2449 Brisbane Q 4001 or hand‑deliver it to your nearest Legal Aid office as the submission method.

Enter the reason or type of hearing for your next court date (for example: mention, committal, trial, plea hearing). Fill only if 'Do you have to go to court or a tribunal? — Yes' is 'Yes'.

Check this box if you do not know what your next court date is for (for example, whether it is a mention, committal, trial, etc.).

Enter the total number of your dependent children who are under 18 years old (including any children you pay child support or maintenance for).

Full name or staff identifier of the person who entered the application into the system.

Date when the application was entered by the staff member.

Enter the full name (and optionally staff ID or initials) of the staff member who took the application.

Enter the full name or staff identifier of the person who took the application.

Enter the date when the application was taken.

Check this box when the application should be assigned to an in-house Legal Aid lawyer (i.e., the matter is to be handled internally rather than referred externally).

Enter the name or internal identifier of the in‑house lawyer to whom this application is being assigned. Fill only if 'Assign to in-house lawyer' is 'Yes'.

Enter the internal file or matter number used by the office to track this application.

Enter the unique client identifier assigned by the office for this applicant.

Enter the date the application was taken (for office use only).

Check this box to indicate the month portion of the 'Date' when recording the date the application was taken (office use only).

Check this box to indicate the year portion of the 'Date' when recording the date the application was taken (office use only).

Check this box to indicate the day portion of the 'Date' when recording the date the application was taken (office use only).

Check this box when an office staff member has seen and verified the applicant's health care or pension card.

Check this box when the applicant's supporting documents (e.g., income statements, court documents) have been received and attached to the file.

Check this box when the office has no in-house capacity to take the client’s matter (i.e., the office cannot assign an in‑house lawyer).

Enter the adviser’s short code or initials associated with the 'Advised by' entry for quick reference. Fill only if 'No in-house capacity' is 'Yes'.

Enter the name or staff identifier of the person who advised that there is no in‑house capacity to take this matter. Fill only if 'No in-house capacity' is 'Yes'.

For office use only: check this box when the conflict-check review indicates there are extra details recorded at question 18 that should be referenced.

Enter a brief description of any other legal matters you are involved in (for example type of matter, parties or case name, relevant dates, court or agency, and your role); leave blank if not applicable. Fill only if 'Are you involved in any 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 currently involved in any other legal matters (for example, child protection or family law).

Check this box if you will provide details about the other legal matters in the adjacent text field.

Enter the first (given) name you have previously used or are known by for this other name. Fill only if 'Yes' is 'Yes'.

Describe the type of other name (for example: maiden name, previous married name, alias or professional name). Fill only if 'Yes' is 'Yes'.

Enter the family (last) name you have previously used or are known by for this other name. Fill only if 'Yes' is 'Yes'.

Check this box if you have used or ever used any other names and will provide those names on the form.

Check this box if you have never used any other names (for example maiden name or a previous married name).

Check this box to indicate you are providing the list of other names in the fields below.

Check this box if the person HAS pleaded guilty in court to the charges listed.

Check this box if the person HAS NOT pleaded guilty in court to the charges listed.

Check this box if the police have applied for a domestic and family violence protection order about this matter (and provide the date in the 'When?' fields if you know it). 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 you know 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 in relation to this matter. Fill only if 'Yes — police have applied for a protection order' is 'Yes'.

Enter the full postal/street address where you can be contacted (for example unit number and street name).

Enter the suburb or town for the postal/contact address.

Enter the postcode or ZIP code for the postal/contact address.

Enter the state or territory for the postal/contact address (use abbreviation or full name).

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

Enter your Integrated Offender Management System (IOMS) number as issued by the prison or detention centre. Fill only if 'Yes (in prison)' is 'Yes'.

Check this box if you are currently not in prison or any detention centre.

Check this box if you are currently in prison or detained.

Check this box when you are in prison and need to provide the name of the prison or detention centre in the adjacent text field.

Enter the date on which the privacy and conflict of interest declaration was signed.

Enter the full name of the person signing the privacy and conflict of interest declaration (or the name of the authorised person signing on the applicant's behalf).

Check this box if recreational vehicles such as boats or caravans are part of the property settlement. Fill only if 'Property settlement' is 'Yes'.

Check this box if a motor vehicle is an asset to be considered in the property settlement. Fill only if 'Property settlement' is 'Yes'.

Check this box if savings (bank accounts, cash holdings, deposits) are part of the property settlement. Fill only if 'Property settlement' is 'Yes'.

Check this box if the home you currently live in is an asset that is part of the property settlement. Fill only if 'Property settlement' is 'Yes'.

Check this box if any other real estate (not the home you live in) is included in the property settlement. Fill only if 'Property settlement' is 'Yes'.

Check this box if superannuation, insurance payouts, or other sellable valuable items are included in the property settlement. Fill only if 'Property settlement' is 'Yes'.

Check this box if shares, bonds, or other investment securities are included in the property settlement. Fill only if 'Property settlement' is 'Yes'.

Check this box if there is an other property/item that is part of the settlement which is not covered by the listed options. Fill only if 'Property settlement' is 'Yes'.

Check this box to indicate you will provide details about the 'Other' item in the adjacent text field.

Enter a brief description of any other property or valuable item that is part of your settlement but not listed above, including any identifying details or context. Fill only if 'Property settlement', 'Other (Property settlement)' is 'Yes' (all).

Check this box if an application for a domestic and family violence protection order has been lodged in court, and attach a copy of the 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.

Check this box if you ARE applying for aid for a family or relationship problem.

Check this box to indicate you should skip the intervening questions and go directly to question 17 (typically used when you answered No).

Check this box if you do have any current orders about this family matter (for example domestic violence protection orders, child protection orders); attach a copy of any order(s).

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

Check this box if the person named in question 15 does not have a lawyer.

Check this box if you do not know whether the person named in question 15 has a lawyer.

Check this box if the person named in question 15 does have a lawyer.

Check this box if you can provide the lawyer’s details (name, law firm, address, etc.) in the fields below.

Enter the lawyer's full name (given and family name) for the lawyer representing the person involved, if known. Fill only if 'Q15 Yes' is 'Yes'.

Enter the name of the lawyer's law firm or practice, if known. Fill only if 'Q15 Yes' is 'Yes'.

Enter the lawyer's street address, including unit/flat number and street name, for the law firm or office. Fill only if 'Q15 Yes' is 'Yes'.

Enter the suburb or town where the lawyer's office is located. Fill only if 'Q15 Yes' is 'Yes'.

Enter the postcode for the lawyer's office location. Fill only if 'Q15 Yes' is 'Yes'.

Enter the state or territory for the lawyer's office location (for example NSW, VIC, QLD). Fill only if 'Q15 Yes' is 'Yes'.

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

Enter the other person's email address.

Enter the other person's given (first) name.

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

Describe the other person's relationship to you (for example: partner, parent, friend, lawyer).

Enter any middle name(s) of the other person, or leave blank if none.

Enter the other person's date of birth.

Enter the postcode for the other person's address.

Enter the other person's family (last) name.

Enter the suburb or town where the other person lives.

Enter the state or territory where the other person lives.

Check this box if you are not applying for aid for a civil law problem (if No, skip to question 18).

Check this box if you are applying for aid for a civil law problem (if Yes, indicate which problem below).

Check this box if your application is about an inquest. Fill only if 'Q17 Yes — applying for a civil law problem' is 'Yes'.

Check this box if your matter involves anti-discrimination law. Fill only if 'Q17 Yes — applying for a civil law problem' is 'Yes'.

Check this box if your civil law problem relates to mental health. Fill only if 'Q17 Yes — applying for a civil law problem' is 'Yes'.

Check this box if your issue relates to dangerous prisoners law or proceedings. Fill only if 'Q17 Yes — applying for a civil law problem' is 'Yes'.

Check this box if your application concerns child protection; if so, go to question 13 on page 9. Fill only if 'Q17 Yes — applying for a civil law problem' is 'Yes'.

Check this box if your matter concerns migration law or immigration issues. Fill only if 'Q17 Yes — applying for a civil law problem' is 'Yes'.

Check this box if your matter concerns domestic or family violence; if so, go to question 13 on page 9. Fill only if 'Q17 Yes — applying for a civil law problem' is 'Yes'.

Check this box if your issue involves peace and good behaviour (restraining order) matters. Fill only if 'Q17 Yes — applying for a civil law problem' is 'Yes'.

Check this box if your civil law problem is about workers' compensation. Fill only if 'Q17 Yes — applying for a civil law problem' is 'Yes'.

Check this box if you are applying for aid for a veteran's appeal (war caused) or another defence-related appeal. Fill only if 'Q17 Yes — applying for a civil law problem' is 'Yes'.

Check this box if you are not sure what area your problem falls into and need legal advice. Fill only if 'Q17 Yes — applying for a civil law problem' is 'Yes'.

Check this box if your civil law problem is an Administrative Appeals Tribunal matter. Fill only if 'Q17 Yes — applying for a civil law problem' is 'Yes'.

Check this box if your civil law problem does not fit any of the listed categories. Fill only if 'Q17 Yes — applying for a civil law problem' is 'Yes'.

Enter a brief description of the civil law problem if it does not match any listed options (provide enough detail to identify the issue).

Describe the disability or health problem that caused you to move out of, or buy another, home if you are 60 years or older. Fill only if 'Q7a — If you are 60 years or older: Yes' is 'Yes'.

Explain your current living situation (for example, moved in with a relative, moved to a nursing home, or moved to a lower-cost house).

Enter the amount of weekly income you receive from the property you still own (for example, rent).

Check this box if the applicant (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 the applicant (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 describing the disability or health problem and how it caused the move or purchase of another home. Fill only if 'Q7a — If you are 60 years or older: Yes' is 'Yes'.

Enter how long you have lived in the home (for example, '5 years' or '10 months'). Fill only if 'Q7a - Yes (the home you live in) — Give details' is 'Yes'.

Enter the date when you purchased or bought the home. Fill only if 'Q7a - Yes (the home you live in) — Give details' is 'Yes'.

Enter the current market value of the home you live in. Fill only if 'Q7a - Yes (the home you live in) — Give details' is 'Yes'.

Enter how much equity you have in the home (market value minus any mortgage owed). Fill only if 'Q7a - Yes (the home you live in) — Give details' is 'Yes'.

Enter the total outstanding mortgage amount currently owed on the home. Fill only if 'Q7a - Yes (the home you live in) — Give details' is 'Yes'.

Check this box if you or a person who helps you financially owns or is paying off the home you live in; selecting it indicates you will provide the requested value, mortgage and equity details.

Check this box if neither you nor a person who helps you financially owns or is paying off the home you live in.

Enter the equity you have in the other real estate property (value minus any outstanding mortgage). Fill only if 'Q7b Yes' is 'Yes'.

Enter the total outstanding mortgage or loan balance secured against the other real estate property. Fill only if 'Q7b Yes' is 'Yes'.

Enter the current market value (sale value) of the other real estate property that is not the home you live in. Fill only if 'Q7b Yes' is 'Yes'.

Check this box if you do own other real estate (for example a rental property or land) and will provide details below.

Check this box if you do not own any other real estate (apart from the home you live in).

Check this box to indicate you will give details about the other real estate you own (value, mortgage and equity) in the fields provided. Fill only if 'Q7b Yes' is 'Yes'.

Enter the total equity you (or the person who helps you financially) have in your motor vehicle(s) as a monetary amount. Fill only if 'Yes (motor vehicle(s))' is 'Yes'.

Check this box if you or a person who helps you financially do NOT own any motor vehicle(s) or are not paying off any vehicle loan.

Check this box if you or a person who helps you financially DO own motor vehicle(s) or are paying off a vehicle loan.

Check this box if you answered Yes and need to provide further details about the motor vehicle(s) and their equity. Fill only if 'Yes (motor vehicle(s))' is 'Yes'.

Enter the total amount of money currently held in the bank account for you or the person who helps you 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 to indicate you will give bank account details (amount and bank account) and attach a copy of bank statements as requested. Fill only if 'Q8 Yes' is 'Yes'.

Provide a brief description of the other valuable asset(s) you have listed for Question 9 (e.g., what the item is and any relevant details such as make, model, or ownership notes).

Enter the dollar value of any other valuable asset (the total amount you can sell or use now) listed as “Other” under Question 9.

Check this box if you or a person who helps you financially have any other valuable assets not listed above and you will provide details in the space provided.

Enter the total amount (in dollars) of superannuation you can access now, insurance payments or any other valuable items you or the person who helps you financially could sell or use now.

Enter the total current value (in dollars) of recreation vehicles such as boats, caravans or similar items that you or the person who helps you financially own and could sell or use now.

Enter the total current value (in dollars) of shares, bonds or similar investments that you or the person who helps you financially own and could sell or use now.

Check this box if you have not been charged with an offence; selecting it directs you to skip to question 13.

Check this box if you have been charged with an offence and you will list the date(s) and details of the charge(s) in the table provided.

Check this box if you need to provide additional details about the charge(s) and will supply those extra details at question 18. Fill only if 'Question 11 - Yes (List your charges)' is 'Yes'.

Enter part of your written description of the legal problem, including what the problem is, who is involved and how, when and how it started, what has happened since, any financial details and any special circumstances that apply.

Enter part of your written description of the legal problem, including what the problem is, who is involved and how, when and how it started, what has happened since, any financial details and any special circumstances that apply.

Enter part of your written description of the legal problem, including what the problem is, who is involved and how, when and how it started, what has happened since, any financial details and any special circumstances that apply.

Enter part of your written description of the legal problem, including what the problem is, who is involved and how, when and how it started, what has happened since, any financial details and any special circumstances that apply.

Enter part of your written description of the legal problem, including what the problem is, who is involved and how, when and how it started, what has happened since, any financial details and any special circumstances that apply.

Enter part of your written description of the legal problem, including what the problem is, who is involved and how, when and how it started, what has happened since, any financial details and any special circumstances that apply.

Enter part of your written description of the legal problem, including what the problem is, who is involved and how, when and how it started, what has happened since, any financial details and any special circumstances that apply.

Enter part of your written description of the legal problem, including what the problem is, who is involved and how, when and how it started, what has happened since, any financial details and any special circumstances that apply.

Enter part of your written description of the legal problem, including what the problem is, who is involved and how, when and how it started, what has happened since, any financial details and any special circumstances that apply.

Enter part of your written description of the legal problem, including what the problem is, who is involved and how, when and how it started, what has happened since, any financial details and any special circumstances that apply.

Enter part of your written description of the legal problem, including what the problem is, who is involved and how, when and how it started, what has happened since, any financial details and any special circumstances that apply.

Enter part of your written description of the legal problem, including what the problem is, who is involved and how, when and how it started, what has happened since, any financial details and any special circumstances that apply.

Enter part of your written description of the legal problem, including what the problem is, who is involved and how, when and how it started, what has happened since, any financial details and any special circumstances that apply.

Enter part of your written description of the legal problem, including what the problem is, who is involved and how, when and how it started, what has happened since, any financial details and any special circumstances that apply.

Enter part of your written description of the legal problem, including what the problem is, who is involved and how, when and how it started, what has happened since, any financial details and any special circumstances that apply.

Enter part of your written description of the legal problem, including what the problem is, who is involved and how, when and how it started, what has happened since, any financial details and any special circumstances that apply.

Enter part of your written description of the legal problem, including what the problem is, who is involved and how, when and how it started, what has happened since, any financial details and any special circumstances that apply.

Enter part of your written description of the legal problem, including what the problem is, who is involved and how, when and how it started, what has happened since, any financial details and any special circumstances that apply.

Enter part of your written description of the legal problem, including what the problem is, who is involved and how, when and how it started, what has happened since, any financial details and any special circumstances that apply.

Enter part of your written description of the legal problem, including what the problem is, who is involved and how, when and how it started, what has happened since, any financial details and any special circumstances that apply.

Enter part of your written description of the legal problem, including what the problem is, who is involved and how, when and how it started, what has happened since, any financial details and any special circumstances that apply.

Enter part of your written description of the legal problem, including what the problem is, who is involved and how, when and how it started, what has happened since, any financial details and any special circumstances that apply.

Enter part of your written description of the legal problem, including what the problem is, who is involved and how, when and how it started, what has happened since, any financial details and any special circumstances that apply.

Enter part of your written description of the legal problem, including what the problem is, who is involved and how, when and how it started, what has happened since, any financial details and any special circumstances that apply.

Enter part of your written description of the legal problem, including what the problem is, who is involved and how, when and how it started, what has happened since, any financial details and any special circumstances that apply.

Check this box if you DO get financial help from another person (for example a relative or partner 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 (no one regularly gives you money, helps pay your bills, or shares living expenses).

Enter the details of any self‑employment, small business or farming for you or the person who financially helps you (for example business name, nature of work, typical hours, income or turnover and any relevant contact information). Fill only if 'Question 4 - Self‑employment: Yes' 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 when you need to provide or attach further details about the self‑employment, small business or farming activity (use the space or attach additional pages).

Enter the name or brief details of the Centrelink or Veterans’ Affairs payment not listed above (e.g., specific payment type or other relevant information). Fill only if 'Other (payment type)' is 'Yes'.

Check this box when the Centrelink or Veterans' Affairs payment received is not listed among the options and should be recorded as 'Other'.

Check this box when you have selected 'Other (payment type)' to indicate you will provide the name/details of that payment in the adjacent text field.

Check this box if the person receives a Youth Allowance payment from Centrelink or Veterans' Affairs.

Check this box if the person receives a Disability Support Pension from Centrelink or Veterans' Affairs.

Check this box if the person receives Parenting Payment (partnered) from Centrelink or Veterans' Affairs.

Check this box if the person receives a Newstart Allowance (now often called JobSeeker) from Centrelink or Veterans' Affairs.

Check this box if the person receives a Veterans' or war-related service payment from Veterans' Affairs or Centrelink.

Check this box if the person receives a Sickness Allowance from Centrelink or Veterans' Affairs.

Check this box if the person receives a Widow Allowance from Centrelink or Veterans' Affairs.

Check this box if the person receives the full-rate of the Centrelink or Veterans' Affairs payment listed.

Check this box if the person receives a Mature Age Allowance or related pension benefit from Centrelink or Veterans' Affairs.

Check this box if the person receives a Special Benefit from Centrelink or Veterans' Affairs.

Check this box if the person receives a Single Parenting Payment from Centrelink or Veterans' Affairs.

Check this box if the person receives a part-rate of the Centrelink or Veterans' Affairs payment listed.

Check this box if you or the person who helps you financially receives a Centrelink or Veterans' Affairs payment (then specify which payment in the following options).

Check this box if neither you nor the person who helps you financially receives a Centrelink or Veterans' Affairs payment.

Check this box if you are a single person who is currently working.

Check this box if you are a single person who is not currently working.

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

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 partner is currently working.

Check this box when you are not completing the application for yourself and are applying on behalf of someone else (e.g., power of attorney, QCAT order, parent, guardian); you must then provide the authority details.

Check this box when you are completing the application for yourself and will read and sign the declaration that follows.

Check this box if you have or had an intimate or romantic personal relationship with the other person. Fill only if 'Domestic/family violence' is 'Yes'.

Check this box if the other person is a family member or relative (including extended or broader family). Fill only if 'Domestic/family violence' is 'Yes'.

Check this box if your relationship with the person is as an informal or unpaid carer who provides regular care or assistance. Fill only if 'Domestic/family violence' is 'Yes'.

Check this box if you are or were in a married or de facto/spousal relationship with the other person. Fill only if 'Domestic/family violence' is 'Yes'.

Check this box if none of the listed relationship types describe your relationship with the other person. Fill only if 'Domestic/family violence' is 'Yes'.

Enter the child's given first name followed by any middle name(s). Fill only if 'Yes' is 'Yes'.

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

Specify how the child is related to you (for example: son, daughter, stepchild, foster child). Fill only if 'Yes' is 'Yes'.

Provide the name(s) or relationship(s) of the person(s) the child normally lives with (for example: mother, father, both, guardian). Fill only if 'Yes' is 'Yes'.

Enter the child's date of birth. Fill only if 'Yes' is 'Yes'.

State whether the child is involved in this matter and, if so, give brief details of that involvement. Fill only if 'Yes' is 'Yes'.

Check this box if the second person charged currently has a lawyer (and you should 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 lawyer’s street address for the firm or solicitor, including unit or suite number if applicable. Fill only if 'Second person charged - Has a lawyer? Yes', 'Second person charged - Has a lawyer? Don't know' is 'Yes' or is 'Don’t know' (any).

Enter the name of the law firm or legal practice representing the second person charged. Fill only if 'Second person charged - Has a lawyer? Yes', 'Second person charged - Has a lawyer? Don't know' is 'Yes' or is 'Don’t know' (any).

Enter the lawyer’s full name (given name(s) and family name) who represents the second person charged. Fill only if 'Second person charged - Has a lawyer? Yes', 'Second person charged - Has a lawyer? Don't know' is 'Yes' or is 'Don’t know' (any).

Enter the suburb or town where the lawyer’s office is located. Fill only if 'Second person charged - Has a lawyer? Yes', 'Second person charged - Has a lawyer? Don't know' is 'Yes' or is 'Don’t know' (any).

Enter the postcode for the lawyer’s office address. Fill only if 'Second person charged - Has a lawyer? Yes', 'Second person charged - Has a lawyer? Don't know' is 'Yes' or is 'Don’t know' (any).

Enter the state or territory in which the lawyer’s office is located. Fill only if 'Second person charged - Has a lawyer? Yes', 'Second person charged - Has a lawyer? Don't know' is 'Yes' or is 'Don’t know' (any).

Enter the second person's full street address including house/unit number and street name.

Enter the person's middle name or names; leave blank if they have none or it is unknown.

Enter the person's given or first name as used on official documents.

Enter the person's family name or surname as used on official documents.

Enter the suburb or town for the person's residential address.

Enter the person's date of birth.

Enter the state or territory for the person's residential address.

Enter the postcode for the person's residential address.

Check this box if you do have special circumstances to report, and you will list the details at question 18 as requested.

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

Enter the third child's first name and any middle name(s). Fill only if 'Yes' is 'Yes'.

Enter the third child's family name (surname). Fill only if 'Yes' is 'Yes'.

Enter how the third child is related to you (for example 'son', 'daughter', 'stepchild'). Fill only if 'Yes' is 'Yes'.

Enter the third child's date of birth. Fill only if 'Yes' is 'Yes'.

Enter the name(s) or relationship(s) of the person(s) the third child lives with (for example 'mother', 'father', 'guardian'). Fill only if 'Yes' is 'Yes'.

State whether the third child is involved in this matter and include brief details if applicable. Fill only if 'Yes' is 'Yes'.

Enter the household’s total gross weekly income before tax in dollars, including all sources of income for everyone in the household.

Check this box if you are 17 years old or younger (if checked you do not need to complete the financial details section).

Check this box if you are not 17 years old or younger (i.e. 18 or older) and must complete the financial details section.

Enter any free‑text notes, comments or additional information relevant to your application or this section of the form.

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

Check this box if at least one other person was charged with you and you need to provide their details.

Check this box if no one else was charged with you; if checked, skip ahead to question 12.

Check this box to indicate you will provide details about the other person(s) charged in the fields below or the following section.

Check this box if your application concerns spousal maintenance or financial support between former partners. Fill only if 'Yes' is 'Yes'.

Check this box if your application involves child protection concerns, including family group meetings or child safety interventions. Fill only if 'Yes' is 'Yes'.

Check this box if your application relates to domestic or family violence issues and you need to provide details or seek protection. Fill only if 'Yes' is 'Yes'.

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

Check this box if your application is to enforce an existing court order or to report that a court order has been breached. Fill only if 'Yes' is 'Yes'.

Check this box if your application relates to child support, maintenance payments, or paternity matters. Fill only if 'Yes' is 'Yes'.

Check this box if your application is about dividing property, assets or the settlement of financial matters between parties. Fill only if 'Yes' is 'Yes'.

Check this box if your application concerns how much time or contact your children have with you or the other parent. Fill only if 'Yes' is 'Yes'.

Check this box if your application is about obtaining a divorce or related divorce proceedings. Fill only if 'Yes' is 'Yes'.

Check this box if your application is about parental responsibility or decisions on schooling, health, religion or other child-raising issues. Fill only if 'Yes' is 'Yes'.

Check this box if you are unsure which specific family or relationship problem applies to your situation. Fill only if 'Yes' is 'Yes'.

Check this box if you would like to get legal advice about your family or relationship problem. Fill only if 'Domestic/family violence' is 'Yes'.

Check this box if your family or relationship problem is not listed among the options and you will specify the problem in the adjacent text field. Fill only if 'Yes' is 'Yes'.

Enter a short description naming the other family or relationship problem not covered by the checklist above. Fill only if 'Other (specify)' is 'Yes'.