Likely Enquiry Form
It is likely that this form will only take you a few minutes to complete. |
 Contact Details |
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| Name: | * |
| Contact Number: | * |
| Email Address: | * |
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 Personal Details |
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| Age: | * |
| Sex: | Male: Female: |
| No. of children: | * |
| Occupation: | * |
How would you describe your traffic record?
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Is a criminal conviction likely to effect
your employment either now or in the future | |
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 Circumstances Of The Offence |
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What offence have you been charged with?
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What reading did you register?
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Is this your first major ofence within 5 years?
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| Why did the police breath test you? | |
| Why were you driving? |
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| What court do you have to attend? | |
| What date you have to attend? |  |
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| Need for a licence |
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| Will you lose your job if you lose your licence | |
| What suburb do you live in | |
| What suburb do you work in | |
| Any other need for a licence | |
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| Ability to pay a fine |
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| How much do you earn each week after tax? | |
| Do you? | Pay Rent: Pay board: Have a mortgage: Own your own home: |
How much is your board / rent / mortgage repayments
per week? | |
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| Any other relevant details |
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Would you like a quote for legal representation?
| Yes No |
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