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Means Test Form (for pro bono referral for individuals)

Step 1 of 5

20%
  • A video showing how to fill in this form is available here: Watch the Video
  • Please play the audio below if you have trouble reading this form.
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  • Please read this information carefully before you apply.

    False Statements

    Law Access needs to know information about your circumstances and legal issue to assess whether you are eligible for assistance.

    You must provide true and complete information.

    If we find your information is false or you have left anything out, you will not get help from Law Access or pro bono lawyers.

  • Information and Documents
    You will be asked to upload documents as part of your application.
    You should scan or save the documents we are likely to need before you start.

    The documents we need will depend on your circumstances but usually include:

    • Bank statements for the last three months for accounts in your name and the name of your partner.
    • Your most recent pay slip (if you are employed).
    • Your most recent Centrelink Income Statement (if you are receiving Centrelink benefits).
    • Any documents relevant to your legal issue including court documents and decisions, letters or emails about your dispute, legal advice you’ve received and anything else that we would need to understand your legal issue.

  • Download the PDF form
  • Drop files here or
    Max. file size: 10 MB.
      Please upload the completed form and all supporting documents.
    • Details of person who requires legal assistance.

    • Please play the audio below if you have trouble reading this form.
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    • If you do not have a phone number, please write none.
    • Home and Money

    • Please play the audio below if you have trouble reading this form.
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      Partner includes husband/wife, defacto and other types of partner where you share your income and expenses or one person provides financial support to the other.
      Tick all that apply.
    • Please also note if they only live with you for part of the week.
      Please tick all that apply.
    • Max. file size: 10 MB.
    • e.g. Jobseeker, Rent Assistance, Carer's Allowance etc.
    • Max. file size: 10 MB.
    • Max. file size: 10 MB.
      Tick all that apply.
    • e.g. Jobseeker, Rent Assistance, Carer's Allowance etc.
    • Max. file size: 10 MB.
    • Max. file size: 10 MB.
    • The next questions ask about you and your partner. If you do not have a partner, just complete the answers for yourself.

    • Such as how often and how much money.
      e.g. If they provide you with money, pay your bills or provide things for you that you would otherwise have to pay for like food or accommodation.
      Tick all that apply.
      Current home means the address you listed as your usual home address. Own includes where you only own a part share of the property or where you have a mortgage or other debt that you have not repaid.
    • i.e. What do you think it would sell for?
    • i.e. In a mortgage or other loan.
      Own includes where you only own a part share of the property or where you have a mortgage or other debt that you have not repaid.
    • i.e. What do you think it would sell for now?
    • i.e. In a mortgage or other loan.
    • Please enter a number from 0 to 10.
      Including individual and joint accounts and those for businesses etc.
    • Drop files here or
      Max. file size: 10 MB.
      • Please enter a number from 0 to 5.
        Including motorbikes, caravans etc.
      • List each vehicle by type or as vehicle 1, vehicle 2 with the value next to it.
      • List each vehicle by type or as vehicle 1, vehicle 2 with the value next to it.
        This includes shares, stocks, expensive jewellery and anything else valuable.
      • About Your Legal Issue

      • Please play the audio below if you have trouble reading this form.
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      • Drop files here or
        Max. file size: 10 MB.
        • My Information

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        • By signing the box at the bottom of this form I accept that:

          1. Law Access relies on the information that I provide and I must provide full disclosure of all relevant information to Law Access to process my application.
          2. Law Access may need to get other information about me or my legal issue and I provide the consent below for my information to be shared with Law Access.

          1. Law Access may share information about my application with others for the purpose of processing my application.
          2. Law Access may publish information about my application for reporting, marketing and promoting Law Access work and pro bono practice but when they do so they will not use my name or other information that would allow me to be identified unless I specifically agree to be identified.
          3. Law Access will keep my information confidential and use it only for my application and not for processing any application by any other applicant.
          4. Law Access may receive or possess information for others whose interest conflict with mine and will not use their information in processing my application. Law Access may still process applications when this happens.
          5. Where there is a conflict of interest, Law Access may refer my application to an independent external party for assessment.

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        Law Access acknowledges the traditional custodians throughout Western Australia and their continuing connection to the land, waters and community. We pay our respects to all members of the Aboriginal communities and their cultures, and to Elders both past and present.

        Please Note: The information on our website does not constitute legal advice. There is no guarantee we will be able to organise pro bono assistance for you, even if you are eligible. Law Access Ltd does not, by referring an applicant or a matter to a particular legal practitioner, law firm, community legal centre or other service, warrant the services of that practitioner, firm, centre or service.

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