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					                                      CRIMINAL LAW                            CLIENT ID

                                                                              DLR / CAR ID
                                       Duty Lawyer Record
                                       Court Attendance Record                FILE ID – LIT / MW

                                       URGENT                                 Child client                  No         Yes


Next action             Resubmit _______________________________                     Send copy to

    Create File (specify type) ______________________________                        Lodge Application (refer to checklist)
    Reporting Letter CR __________________________________                           Request Brief / ROI / ROI Transcript
    Book Interpreter _____________________________________                           Check Counsel / PDU Availability
    Other                                        See File Instruction Sheet          Close MWF              No further action



Client preference for representation            VLA (specify office)     _____________________________________          Private
Advocate wishes to retain file                  Yes         No



Client name                                                                          Client DOB


    Custody                    Bail             Summons

Practitioner                                                                         Date / Time

Referred from                                                                        Court ref no

Court / Tribunal                                                                     Location

Work type
    Mention                   Contest mention          ROPES / Diversion             Committal mention
    Bail                      Plea                     Filing hearing                Other

Judge / Magistrate

Prosecutor                                                                           Informant


Matter type                    No. Non-appearance outcome                  Adjourned          Referred to          Referral reason
(List primary matter first)          Information only                      date
                                     Procedural advice only
                                     Legal advice only
                                     Advice and information
                                   Appearance - specify outcome




NOTE: If an Application for Aid has been completed, the Client details section on page 2 is NOT required

VLAGEN1310_12062012                               Duty Lawyer / Court Attendance Record – Crime                                 Page 1
Client details (Please complete all questions)
1. Personal details                                                       5. Disability
Title      Mr         Mrs          Ms     Miss       Master          Dr   Do you have a disability?
First name           __________________________________                      No             Not stated (Go to Question 6)

Middle name          __________________________________                      Yes         What kind of disability?

Surname              __________________________________                      Acquired brain injury        Intellectual         Hearing

Have you used any other names?                          Yes          No      Mental health                Physical             Speech

If YES, please state other names: __________________                         Visual                       Not disclosed        Other

______________________________________________
                                                                          6. Employment status
                                                                          What is your employment status?
Gender                Male           Female         Not applicable
                                                                             Full time      Part time       Casual        Not employed
Date of birth _____/_____/_____                  If estimate, tick
                                                                          What work do you do? __________________________
2. Contact details
                                                                          How much do you earn each week after tax? $ _______
Are you homeless?                                       Yes          No
                                                                          Do you support someone financially?              Yes          No
Where do you live?
                                                                          Does anyone support you financially?             Yes          No
______________________________________________
                                                                          7. Benefit details
___________________________                   Postcode _________
                                                                          Do you have a health care card?                  Yes          No
Is this where you usually live?                         Yes          No
                                                                          Are you on a benefit?         No (Go to Question 8)
Can we send mail to this address?                       Yes          No
If no, where can we write to you?                                            Yes      What type of benefit do you receive?

______________________________________________                               ABSTUDY                    Age pension            Austudy

___________________________                   Postcode _________             Carer payment              Disability support pension

Do you prefer to be contacted by email?                 Yes          No      Newstart allowance         Parenting payment

Email address __________________________________                             Partner allowance          Sickness allowance

Phone contact numbers:                                                       Special benefits           Veterans/war service

Home       _____________ Mobile __________________                           Widow allowance            Widow B pension

Work       _____________ Other ___________________                           Wife pension               Youth allowance        Other
                                                                          Do you receive the maximum rate of benefit?
3. Origin
                                                                             Yes             No
Country of birth ________________ Year of arrival ____
                                                                          8. Living arrangements
Are you of Aboriginal or Torres Strait Islander origin?
                                                                          What are your usual living arrangements?
    No        Aboriginal           Torres Strait Islander        ATSI
                                                                             Single          Married           Living with partner
4. Language
Do you speak a language other than English at home?                          Separated from partner            Married but separated

    No (Go to Question 5)                                                    Divorced        Widowed           Not applicable/Other
    Yes         Which language? ______________________
Do you need an interpreter?                             No                Custody details: VLA use only
    Yes         Which language? ______________________                       Custody/detention location ____________________
How well do you speak English?                                            Date remanded into custody or detention         . ___/___/___
    Very well               Well          Not well           Not at all   Expected release date _____/_____/_____
How well do you read English?
    Very well               Well          Not well           Not at all

Victoria Legal Aid                                                                                                             Page 2
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Victoria Legal Aid                                                                     Page 3
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Victoria Legal Aid                                                                     Page 4

				
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