Client Information Form
*denotes mandatory field
Title * MrMrsMissMsDrOther
First Name *
Middle Name(s) *
Last Name *
Preferred Name *
Date of Birth (dd/mm/yyyy) *
Residential Address *
Postal Address (if different to residential address)
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 *
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.