Name
*
First Name
Last Name
Phone Number
*
-
Email address
*
What is your financial situation? (so we can assess your eligibility to our services)
*
I receive my income from Work and Income? (Benefit or Superannuation)
I am unemployed
I earn minimum wage (currently $22.70 per hour)
Other (Please enter your yearly income here. e.g. $45,000 pa)
Please tell us a little bit about your legal problem, including the area of law (e.g. family law)
*
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Who else is involved - e.g. if you are having problems with your boss we will need their name and the name of the company your work(ed) for.
*
Please provide the NAMES of the other people or organisations involved in your matter and details on how they are involved - e.g. your neighbour, employer, etc. NOTE: We will not contact the other people involved in your issue.
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How did you hear about us?
Please Select
Citizens Advice Bureau
Community Organisation
Court
Internet
Law Related Education seminar/webinar
Lawyer/Solicitor
Marae
MP/Electoral Office
Police
Previous visit
Radio/Newspaper
School
Whaanau/Family
Word of mouth
Friend
Government Department
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