Means Assessment Application Details- ClientsCCMS APP No.(Required) Date Application Received(Required) DD dash MM dash YYYY Preferred Language(Required)EnglishiTaukeiHindustaniOtherTitle(Required)MrMrsMsMissDrEnter full name(Required) Date of Birth(Required) DD slash MM slash YYYY Residential Address(Required) Street Address City/Town Postal Address Contact NumberOffice Application Received(Required)S01- 41 Loftus Street, Legal Aid BuildingS02- 16 Kimberly StreetS03- 73 Gordon StreetS05- Nasinu- Valelevu Complex Ground FloorS05/2 Nasinu- Valelevu Complex Level 1S06- Nausori Level 1 YM Haniff ArcadeS07- Korovou Waimaro Ciricuit Society BuildingS08- Navua Ro Matanitobua ComplexS09- Sigatoka Level 1, Magistrate’s Court ComplexS10- Nadi 1st Floor, Units 10-13 GT PlazaS11- Lautoka Level 1, Magistrate’s Court Complex Tavewa AvenueS11/2- Lautoka Marine DriveS12- Ba Magistrate’s Court Complex Old Bridge RoadS13- Tavua 1st Floor, Dalpat Singh Building Opposite Tavua Magistrate Court Nasivi StreetS14- Rakiraki 1st Floor, Naidu Investments Limited Building Vaileka Sub Division Main StreetS15- Labasa Old Court House Building Jaduram StreetS16- Savusavu Level 1, Vunilagi House Main StreetS17- Seaqaqa 70, Seaqaqa TownshipS18- Nabouwalu Naulumatua HouseS19- Taveuni First Light Inn Building Ground FloorS20- Levuka Lomaiviti Holdings Building Beach StreetS21- KeiyasiS22- VunidawaS23- KadavuS24- RotumaType of Matter(Required)Family LawCriminal LawCivil LawWhere is the court?(Required)SuvaLautokaLabasaNasinuNausoriNavuaNadiBaRakirakiTavuaKorovouSigatokaLevukaSavusavuTaveuniKeiyasiRotumaVunidawaIsland CourtCourt Case Number(Required) Next Court Date DD slash MM slash YYYY Income & AssetsWhat is your gross monthly income?SourceAmount Add RemoveTotal AssetsType of AssetValue Add RemoveExpenses & LiabilitiesWhat are your monthly expenses?ExpensesAmount Add RemoveTotal LiabilitiesType of LiabilitiesValue Add RemoveClient Information Officer VettingOfficer Name(Required) First Last Email(Required) How were the assets acquired ? Does the Applicant have the ability to raise money for the satisfaction of legal cots from above mentioned income & assets ? Can the above Assets be realised to pay legal fees?(Required) Yes No What is the yearly net income/earnings per annum?(Required) Does the Applicant meet the threshold of net $15,000 per annum?YesNoIs the application ?(Required)QualifyDoes Not QualifyRecommended to:(Required)AprroveRejectNote Vetting by Legal OfficerOfficial Legal Officer StampRemarks Date DD slash MM slash YYYY Recommend to: Approve Reject Vetting by Officer In Charge / Head Of UnitOfficial Legal Officer StampRemarks Date DD slash MM slash YYYY Recommend to: Approve Reject
