Commonwealth of Australia

APPLICATION FOR APPROVAL OF THE 
DEFENCE FORCE DISCIPLINE APPEAL TRIBUNAL
TO THE GRANTING OF LEGAL AID

This form may be completed by an applicant seeking the approval of the Defence Force Discipline Appeal Tribunal to the granting of legal aid under Regulation 11 of the Defence Force Discipline Appeals Regulations.

The form should be fully completed.  Please type or print neatly and answer ALL questions.  Consideration of the application may be delayed if all information (including attachments) is not provided.  If the space provided is insufficient, include additional material on a separate page and attach it to the form.
The information provided on this form is required to assess if the applicant has insufficient means to enable him or her to prosecute his or her appeal or other application and whether, in the interests of justice, it is desirable that legal aid be granted to the applicant.

This form must be signed in the presence of a Justice of the Peace, Commissioner for Declarations, legal practitioner or other authorised person before whom a statutory declaration may be made.

This form and all attachments should be sent to:

The Registrar
Defence Force Discipline Appeal Tribunal
C/- Federal Court of Australia
Commonwealth Law Courts Building
Childers Street
CANBERRA ACT 2601

A.	PARTICULARS OF APPLICANT

SURNAME	GIVEN NAME(S)

ADDRESS:	

	Postcode:	

TELEPHONE Nos: Home:	Work:	Mobile:		

DATE OF BIRTH

             /           /
	PLACE OF BIRTH

Australia 	Overseas	

IF BORN OVERSEAS:

What country were you born in?	

What year did you arrive in Australia?	

EMPLOYMENT STATUS:

Employed	Self Employed

Unemployed	Not Applicable

ARE YOU IN RECEIPT OF SOCIAL SECURITY BENEFITS (other than the family allowance) OR OTHER GOVERNMENT BENEFITS, PENSIONS, ALLOWANCES OR PAYMENTS?

YES	NO

I yes, advise type or types and paying agency	

	

B.	YOUR SOLICITOR (if applicable)

SOLICITOR’S NAME:

NAME OF SOLICITOR'S FIRM:

ADDRESS:	
	
	POSTCODE	
TELEPHONE	FACSIMILE	DX	

C.	OTHER FUNDING
Please attach a copy of any letter of refusal you have received.

Have you applied for legal aid or assistance from another body.

YES	NO

If yes, to whom did you apply?

D.	REASONS (OTHER THAN FINANCIAL) WHY LEGAL AID SHOULD BE GRANTED
	Please provide details of why it is desirable, in the interests of justice, that legal aid be granted to you, attaching copies of any documents to support this.

	

	

	

	

	

	

E.	DEPENDANTS
	List husband/wife/partner and dependant children

Name	Date of Birth	Relationship to you	Living with?	

				

				

F.	OCCUPATION

Applicant	Financially associated person	

		

G.	INCOME AND COMMITMENTS DETAILS:  APPLICANT AND FINANCIALLY ASSOCIATED PERSON

•		If employed, attach a copy of latest tax return and a copy of latest pay slip.
•		If self-employed, attach a copy of latest financial statements or tax return.
•	If your business is incorporated, attach a copy of the company’s latest financial statements, and copies of financial statements for all related companies.
•	If unemployed, attach a copy of latest tax return and a copy of latest benefit statement.

WEEKLY INCOME

Include pensions, compensation, unemployment or sickness benefits, rents, interest, dividends and any other income.
Applicant
$	Financially associated person
$	
Gross weekly wage,
Salary or earnings

Other source of income

		
Total:		

WEEKLY COMMITMENTS

	Applicant
$	Financially associated person
$	
Tax (incl Medicare)
			
Rent
			
Mortgage payments on dwelling in which applicant lives			
Board or lodging
			
Maintenance payments to spouse and/or children of applicant			
Payments under hire-purchase and credit sales agreements, loan agreements for motor vehicle(s), household goods and furniture (identify each item)			
Superannuation and life insurance:
Other insurance (give details):			
Child minding fees paid to enable income to be earned			
Garnishee or other court orders (give details)			
Food			
Clothing			
Gas/Electricity			
Telephone			
Travel and motor vehicle			
Other commitments (eg business expenses)			

Total:			

H.	ASSETS

	Applicant
$	Financially associated person
$	
RESIDENCE
Address:

Market value:

If mortgaged, amount still owing on mortgage(s):

OTHER REAL ESTATE
House and/or land other than residence - give details as above

HOUSEHOLD GOODS, FURNITURE, AND PERSONAL EFFECTS
Approximate value:

Amount owing (if any):
			
MOTOR VEHICLE
Year, model and type:

Market value:

Amount owing, if any:
			
Savings held either solely or jointly with any other person			
Shares, debentures etc (give details)			
All money owing to you, and who owes it to you (give details)			
All other assets (eg surrender value of life insurance policies, value of interest in partnership or business)

			
I.	LIABILITIES

	Applicant
$	Financially associated person
$	
Any liabilities you consider should be taken into account showing hardship eg accumulated debts (specify)

J.	CONTRIBUTION

Are you able to contribute towards the expected cost of the proceedings

YES	NO

If yes, how much?    $

CHECK LIST

HAVE YOU

•	completed all parts of the form?
•	attached copies of letters of refusal from other bodies you have applied to for assistance, if any?
•	attached a copy of your latest tax return (and of any financially associated person)?
•	attached a copy of your latest pay slip (and of any financially associated person), or if you are unemployed, a copy of your latest benefit etc statement (and of any financially associated person)?
•	attached a copy of your company's financial statements (including related companies), if any?

STATUTORY DECLARATION BY APPLICANT

I, .........................................................................................................................................
	(full name)	(occupation)
of ........................................................................................................................................
	(address)
do solemnly and sincerely declare:
1.	The information set out in this application is true and correct to the best of my 	knowledge and belief.
2.	Where any estimate is given, it is given in good faith.
3.	I have not disposed of any assets for the purpose of qualifying for assistance.
4.	I undertake to notify the Legal Assistance Branch, Attorney-General’s Department*, of any change in my financial circumstances which could affect my eligibility for continuing financial assistance.

I make this solemn declaration by virtue of the Statutory Declarations Act 1959 and subject to the penalties provided by that Act for the making of false statements in statutory declarations, conscientiously believing the statements contained in this declaration to be true in every particular.

	.......................................................
	(Signature of applicant)

	DECLARED AT ...............................................................................

	THE ............................ DAY OF .................................. 20..............

	BEFORE ME .....................................................
			(JP, Commissioner for Declarations or other authorised person before 			whom a declaration may be made)
	....................................................................................
		(name)
	...................................................................................
		(qualifications)
	...................................................................................................................
		(address)

*	Although the Tribunal is responsible for approving the granting of legal aid to an applicant, the Legal Assistance Branch of the Attorney-General’s Department is responsible for the administration of the legal aid granted.

REPORT BY SOLICITOR ABOUT THE APPLICATION (if this form is completed with the help of a solicitor)

[Cross out whichever does not apply]:

1.	I am the solicitor for the applicant.

	Although I do not represent the applicant, I have helped the applicant to complete this 	Form.

2.	It is my opinion, for the reasons set out below:

	that the applicant has reasonable prospects of success
		that the applicant has good grounds for being represented
		that there is a point of general importance under military disciplinary law 			involved in the proceedings described in this application

3.	My reasons for these opinions are:

4.	I estimate the applicant’s legal costs and expenses of the proceedings, at local legal aid rates, at $.............................

DATED THIS ................................. DAY OF ...................................... 20.....

	....................................................................................
	(Signature of solicitor)

	...............................................................................
	(Name of solicitor)

	...............................................................................
	(Name of firm)