Date
Client ID
PLEASE PRINT ALL DETAILS CLEARLY AND COMPLETE BOTH PAGES
ABOUT
YOU (you must complete this section)
Family / Surname (no abbreviations/nicknames please)
Have you been known by any other name
(i.e. maiden name/before name change)?
Given name(s) (no abbreviations/nicknames please)
No
Yes:
Preferred name (for us to address you by)
CC
What was that name?
Date of Birth dd/mm/yyyy
Address
Suburb
Contact number
Email
Gender
Do you identify as trans/intersex?
State
Postcode
Please let us know if you do not want us to contact you on any of the above (i.e. for safety or privacy reasons)
and let us know how best to get in contact with you if we need to.
THE OTHER PERSON (you must complete this section)
What is the name/s of the other person/s, company/ies or organisation/s in your dispute?
Date of Birth dd/mm/yyyy
Has the other party been known by any other name?
No
CC
What was that name?
Yes:
YOUR LEGAL PROBLEM (you must complete this section)
In a few words, what type of legal problem do you have (i.e. ‘family law’, ‘discrimination’, ‘criminal’):
CLSIS Code
(office use only)
Please include more details on page 2
Yes – different issue
Have you ever received advice from LGBTI Legal Service before?
OTHER
Yes – same issue
No
(for statistics purposes only – you do not have to complete this section if y ou do not want to)
Why did you approach the
LGBTI Legal Service?
I feel my issues would be better addressed by a lawyer with
specific LGBTI experience
I can’t afford a private lawyer
Other – specify:
I feel safer/more comfortable
Who referred you to the
LGBTI Legal Service?
Legal Aid
Government department
Self/Family/Friend
Office of Fair Trading
Other CLC
Child Support Agency
Private solicitor
BSA
Court
Adult Guardian
Other – specify:
Have you attempted to get legal assistance from Legal Aid in relation to your problem?
Application refused
Application lodged
Your relationship
Grant ceiling exceeded
Couple with dependents
Couple (no dependents)
Sole parent with dependents
Single (no dependents)
Torres Strait Islander
Both
Aboriginal
Neither
No
Other
Other – specify:
Main language spoken at home
You identify as
Do you have a disability?
Yes
No
Current household
income
None
Medium ($35,000 - $65,000 p/a)
Low (under $35,000 p/a)
High (over $65,000 p/a)
Country of birth
Income source
Earned (wage, salary)
Other (Workers Comp, Super, Investments)
Govt Pension/Benefit
None
Privacy and Confidentiality
The Service abides by the National Privacy Principles contained in the Commonwealth Privacy Act 1988. Personal
information supplied to us is confidential and will not be given to anyone else unless authorised. We are required to
provide statistical information a bout our services to our funding bodies. However, your personal details and the details
of your legal problem are not provided to our funding bodies, but are necessary for the internal records of the Service.
PLEASE PROVIDE DETAIL S OF YOUR LEGAL PROB LEM.
IF YOU NEED MORE SPAC E, JUST ASK US FOR MORE PAPER.
PLEASE ALSO GIVE US ANY DOCUMENTS YOU WOU LD LIKE THE LAWYER TO SEE.
PLEASE WRITE LEGIBLY
I authorise the LGBTI Legal Service Inc to retain my private information for a period of seven years from the
date of my last advice/contact with the service, after which time it will be destroyed.
Client signature:
Date:
Would you be comfortable with a law student sitting in on your consultation?
Yes
Thank you for completing this form.
Please email it to [email protected].
No
L a w ye r u s e o n l y
LEGAL ADVICE
Date:
File No:
Name:
Type/s of law discussed:
PLEASE SEE EVENING CO-ORDINATOR FOR REFERRALS
Referral list given:
Referred to:
Yes 
No 
1.
If giving referrals, 3 MUST be given
2.
3.
Limitation date: ________________________________
Limitation dates:
A.
B.
C.
D.
N/A
Client advised of limitation date?

Personal Injury Claims: general – 3 years to start court action
Personal Injury: general personal injury (PIPA)

notice of claim to be given by claimant to the particular person whom you believe to be the respondent within 9
months of the accident, but if a claimant consults a non-CLC lawyer beforehand, within 1 month of that consultation,
whichever is the earlier.
Personal Injury: motor vehicle accident (MAIA)

notice of claim to be given by claimant to insurer within 9 months of the accident, but if a claimant consults a lawyer
(including a CLC lawyer), within 1 month of that consultation, whichever is the earlier

within 3 months after the motor vehicle accident, injured person to notify nominal defendant of the claim, if the motor
vehicle cannot be identified
Unfair Dismissal – check relevant legislation (shortest period 21 days)
Debt and / or breach of contract – 6 years
Other (eg Work cover, judicial review, filing of defence, enforcement etc.)
Please specify:
Family limitation dates and notices:
E.
F.
A.
Family Court Application for Property settlement and spousal maintenance – within 12 months of divorce becoming final
B.
De facto Property settlement application – 2 years
C.
Client advised on section 63 DA Family Law Act matters
D.
Client advised on severance of joint tenancies, changes to will and nominations of beneficiary to super/life policies
E.
F.
Child Birth Expenses – within 12 months from birth of child
Child Support

Objection to Child Support Registrar – 28 days

Appeal to SSAT – 28 days

Other – please specify:
Family Provision – 6 months notice and 9 months to commence proceedings
G.
Yes














ADVICE GIVEN – PLEASE WRITE LEGIBLY
Volunteer Lawyer Must Sign
ADVISOR’S NAME & SIGNATURE
CHECKED (NP/RP):
PTO
Volunteer Lawyer Must Sign
ADVISOR’S NAME & SIGNATURE
CHECKED (NP/RP):