Wills Official Use OnlyEnter your Full Name* First Last LAC Employment Number*Example: (LAC00999) LAC Email* Office Location*Example: (Loftus or Kimberly) Application Details- ClientsPreferred LanguagePlease select the language that you wish to be consulted in English iTaukei Hindustani Other Title* Mr Ms Enter your full name* Date of Birth* DD slash MM slash YYYY Place of Birth* Residential Address* Street Address City/Town Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Phone Contact (Landline or Mobile)*Valid ID (Driving License,Passport,Voter, Student ID,FNPF)* Drop files here or Select files Max. file size: 64 MB. Email addressThis is so that we can send your application details back to you for your records. Have you applied for legal assistance before?* Yes No Please answer the following* Do you have difficulty seeing, even if wearing glasses? Do you have difficulty hearing, even if using a hearing aid? Do you have difficulty walking or climbing steps? Do you have difficulty remembering or concentrating? Do you have difficulty (with self-care such as) washing all over or dressing? Using your usual language, do you have difficulty communicating, (for example understanding or being understood by others)? None of the above is required. WILLS Instruction SheetPART 1: PERSONAL DETAILS OF TESTATOR(IX):The Testator is the person who is making the Will. A Testator must not be under eighteen (18) years of age.Time Hours : Minutes AM PM Is there any previous name or names by which you were/are known?* Yes No Name First Last Occupation (If retired, last occupation) What is your marital status?* Single Divorced Widowed Separated Married Other If Married, please provide full names of Spouse and where married: First Last If Divorced or Re-married, please provide names of previous wife(s) Do you have any children (whether adopted, fostered, stepchildren etc)? If yes, please provide the following information:* Yes No If yes, please state belowNameRelationshipCurrent ageAddressOccupation Add RemoveList name, age, addresses, occupation and relationship of any other person(s) who is currently or have been financially dependent on you?NameRelationshipCurrent ageAddressOccupation Add RemoveDo you have an existing Will?* Yes No If yes, when was it created and where is it currently held?* Please attach copy if possibleMax. file size: 64 MB.Do you hold or have you given a power of Attorney to any one?* Yes No If yes, please attach a copy if possible.Max. file size: 64 MB.PART2: EXECUTOR AND TRUSTEE:These are the people who carry out your wishes as stated in your Will. You only have to appoint one (1) but may appoint more.Who is to be the Executor(s) / (ix) of the Will? If more than one, please list them accordingly. Are there any minors mentioned? Yes. If you appoint a minor to be your Estate’s trustee, then should this minor not attain the age of majority at the time of your death, then the Estate may suffer.NameAddressRelationship to TestatorOccupation Add RemoveReasons why you appoint the above person(s): Should your chosen Executor(s)/ (ix) die before you, who is to be the alternative Executor & Trustee?NameAddressRelationship to TestatorOccupation Add RemoveIs there any specific powers you would like the Executor(s) to have? Yes No If yes, please state* Are there any special requests as to burial or cremation? PART 3: GUARDIANSHIP:Guardians are the people you wish to care for any infant children you have at the time of your death.Is there any person(s) you would like to care for any of your children under the age of 18? Yes No If yes, please state below:*NameAddressRelationship to TestatorOccupation Add RemovePART 4: ASSETS AND INVESTMENTS:List all your asset(s) and investment(s)Examples: House, Land, Vehicles, Monies, FNPF, Shares in Stock Exchange or Life Insurance PoliciesAssets/InvestmentSolely/Jointly OwnedEncumbrancesDetails Add RemoveList all your Liabilities (e.g., mortgages, charges) and your indebtedness: Add RemovePART 5: LEGACIES, BEQUESTS AND DEVISES:What asset(s) and to whom would you like to leave it to?Asset(s)Name (person(s)/ organization)Relationship with person(s)What proportion?Reasons: Add RemoveWould you like to create a Trust / Life interest / Right of Occupancy in relation to any property (ies) / asset(s)?* Yes No If Yes, please state* PART 6: SPECIFIC GIFTS: (e.g. cash, jewellery, house contents, real property etc.):These are gifts of specific amounts of money or objects that you wish to make to a particular person. These objects will not pass with the balance of your Estate. If you are planning to leave all of your assets to a single person you do not need to make specific gifts and should go direct to distributions.State the specific gifts with person name: PART 7: RESIDUES:DISTRIBUTION OF THE BALANCE (OR RESIDUARY) OF YOUR ESTATE: The people named to receive the balance of your estate will receive everything you have not already given to any person as a specific gift. If there is only one beneficiary please list an alternate beneficiary in case the first beneficiary has died before you or is unable, for some other reason to take the assets you have left to him or her. If the balance is to be shared between a number of people please indicate the share each person is to receive keeping in mind all percentages should add up to 100 and all fractions to one. You can name as many or as few people as you wish.Who would you like the residue of your assets to be bequeathed / devised to? If the beneficiary is under 18, insert age beneficiary needs to reach to obtain share.NameAgeAddressRelationship To TestatorOccupation Add RemovePART 8: OTHER MATTERS:Are you a beneficiary of any Trusts?* Yes No If Yes, Name of Trustee:* Name of Appointor* Date Trust came into operation:*(Please provide a copy if possible) Do you conduct any business?* Yes No Structure of Business (ie, company, partnership, sole trader)* Company name:* Shares held by you:* Who are the other Shareholders / Partners?* PART 9: ADDITIONAL DRAFTING INSTRUCTIONS:UntitledPART 10: APPOINTMENT DATE TO EXECUTE THIS WILL:Date* DD slash MM slash YYYY PART 11: REGISTRATION OF THIS WILL:Would you like the Commission to register your Will?* Yes No PART 12: DECLARATIONI hereby declare that the abovementioned information given is true and correct and that the Legal Aid Commission will not be held liable or responsible for any liability arising from my above instruction which is given by me on my own free will without any pressure, force or influence from anyone.Signature of the Testator Date DD slash MM slash YYYY Time Hours : Minutes AM PM Place/Address Street Address City Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Witnessed after explanation/interpretation: First Last Date Time Place Occupation Signature Is there any other Witness Yes No Witnessed after explanation/interpretation: First Last Date Time Place Occupation Signature Terms and Condition/ Disclaimer*You MUST provide all relevant information and documentation to enable the Legal Aid Commission to provide you with appropriate legal advice/service. You may be requested to visit the nearest Legal Aid Commission branch for face-to-face consultation. Any advice given online and in-person is based on the information and documentation provided to us and as such it is assumed as correct and accurate. Our legal advice and opinion may change or differ if the information furnished to us was or has been altered in any way, if we have not been furnished with accurate information either deliberately or otherwise, and/or based on any other information which may become available later. The Legal Aid Commission shall not be held liable for any advice rendered based on false, misleading, altered, incorrect, and/or partially provided information. Agree Disagree