Form 2
APPLICATION TO REDUCE FEE
In the Supreme Court of Western No. of 2
Australia
Plaintiff/Appellant*:
(*strike out word that is not applicable)
Defendant/Respondent*:
(*strike out word that is not applicable)
Fee type for which request is made:
❑ Application ❑ Hearing fee ❑ Transcription ❑ Other (please
fee fee describe below)
Concession Card Holder: Pension Concession
Card No: ______________
Yes ❑
No ❑ Health Care Card No:
______________
Grant of Legal Aid under a
legal aid scheme or service
❑Yes ❑ No
Full Name:
Please indicate your party type:
❑ Individual ❑ Entity
Applicant Details:
Address:
Date of Birth:
If you are applying for a fee reduction because of financial hardship or in the
interests of justice, please give supporting reasons for your request (attach a
separate page if required). If the reasons include financial hardship you must
complete the information on the following pages.
I certify that the above information and disclosures in this form are true
and correct.
Applicant’s Signature Dated:
*Note: A person who makes a statement or representation in this application
that the person knows or has reason to believe is false or misleading in a
material particular commits an offence under the Supreme Court (Fees)
Regulations 2002 regulation 8B(1).
COURT SEAL
Page 1 of 5
Page 2 of 5
FINANCIAL DETAILS: APPLICANT WHO IS AN INDIVIDUAL
If the reasons for application include financial hardship, the following sections
of the form must be completed by the applicant if the applicant is an individual.
Occupation:
Employer:
Employer’s Address:
Marital Status: ❑ single ❑ married ❑ partner
❑ de facto ❑ separated
Dependants: ❑ dependant wife/husband/partner/de facto
_____ (number of) dependant children
INCOME AND FINANCIAL ASSETS DETAILS
Income / financial assets (net) Self Partner Total
Wage / salary / benefit $ _______ $ _______ $ _______
Money in financial institution
$ _______ $ _______ $ _______
Cash $ _______ $ _______ $ _______
Income from investments $ _______ $ _______ $ _______
Other income $ _______ $ _______ $ _______
Money loaned and to be repaid
$ _______ $ _______ $ _______
Total $ _______ $ _______ $ _______
Page 3 of 5
EXPENDITURE DETAILS
Expenditure Self Partner Total
Rent / board $ _______ $ _______ $ _______
Mortgage payment $ _______ $ _______ $ _______
Maintenance for dependants $ _______ $ _______ $ _______
Food $ _______ $ _______ $ _______
Utilities (gas / electricity) $ _______ $ _______ $ _______
Telephone $ _______ $ _______ $ _______
Water $ _______ $ _______ $ _______
Rates and taxes $ _______ $ _______ $ _______
Court orders $ _______ $ _______ $ _______
Credit card/s $ _______ $ _______ $ _______
Other debts (provide details)
______________________ $ _______ $ _______ $ _______
Total $ _______ $ _______ $ _______
TOTAL INCOME TOTAL
$ ________ EXPENDITURE $ _______
ASSETS VALUE
House or other property (provide addresses) $ ______
Motor Vehicles 1 Year:
(car, utility,
Make:
motorcycle, truck $ ______
etc.) Model:
Registration Number:
2 Year:
Make:
$ ______
Model:
Registration Number:
Other assets (provide details)
$ _______
TOTAL ASSET VALUE $ ______
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HOME CONTENTS (please complete appropriate box where applicable)
Television DVD Computer Other Dishwashe Micro
player s electronic r wave
devices
$ _______ $ _______ $ ______
$ _______ $ ______ $ _______
Furniture Collection of Other Other assets Interests in
coins, stamps collectables business or
etc. company
$ _______ $ ________ $ ________ $ ________ $ _______
LIABILITIES TOTAL
Mortgage to: $ _______
Other to: $ _______
Time to Pay Order: $ _______
TOTAL LIABILITIES $ _______
FINANCIAL DETAIL: APPLICANT WHO IS NOT AN INDIVIDUAL
If the reasons for application include financial hardship, the following sections
of the form must be completed by the applicant if the applicant is an entity.
Income $ _______
Assets $ _______
Liabilities $ _______
TOTAL $ _______
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