Client Information Form

*denotes mandatory field

    Title *

    MrMrsMissMsDrOther

    First Name *

    Middle Name(s) *

    Last Name *

    Preferred Name *

    Any Aliases

    Date of Birth (dd/mm/yyyy) *

    Residential Address *

    Postal Address (if different to residential address)

    Home Number

    Mobile Number *

    Email Address *

    Preferred method of contact *

    Telephone callSMSEmail

    Next of Kin's full name *

    Next of Kin's Relationship to you *

    Next of Kin's Contact Number *

    Your Occupation

    Your Position

    Your Accountant

    Are you an Australian Citizen *

    YesNo

    Are you a Permanent Resident *

    YesNo

    If you are a Permanent Resident, please provide further details:

    Do you have a Will? *

    YesNo

    Do you have an Enduring Power of Attorney? *

    YesNo

    Do you have an Advance Health Directive? *

    YesNo

    If yes to any of the above, where are your documents located?

    Do you have any other instructions, special requirements or requests?

    How did you hear about us?

    I understand and acknowledge the following:- 1. This in no way constitutes a formal retainer agreement; 2. I have not yet engaged Terra Firma Law to act for me; 3. Terra Firma Law will not act for me or take any action whatsoever on my behalf to protect my interest until such time as I enter into a formal retainer agreement by signing a Disclosure Notice and Cost Agreement and pay funds upfront.

    Yes, I agreeNo, I don't agree

    Please note, for your initial consultation You will be required to produce:-

    • Passport AND driver licence; or
    • Passport OR driver licence AND birth certificate issued by the Registry of Births Deaths & Marriages AND Medicare Card.

    Proof of any name change will also be required.

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