Client Questionnaire

PRIVATE AND CONFIDENTIAL
THE CONTENTS OF THIS FILE ARE STRICTLY CONFIDENTIAL AND ARE THE SUBJECT OF CLIENT ATTORNEY SOLICITOR CLIENT AGREEMENT. NO DOCUMENT HEREIN CAN BE PRODUCED OR COPIED WITHOUT THE EXPRESS CONSENT OF THE PRINCIPLE* ATTORNEY SOLICITOR. IN THE EVENT THAT THE FILE IS MISPLACED* OR LOST – PLEASE TELEPHONE AUSTRALIA 61 7 46 978218 OR FACSIMILE AUSTRALIA 61 7 46 978006.
Case
Case Ref
Principle
D/O/E
P/O/E
Manager/s
VICTIM’S ANTECEDENTS
This section of the Questionnaire is devoted to details about the victim – where the victim is either (A) Deceased, (B) Incapacitated and / or unable to represent their own interests – as in the case of a minor In the event that the victim is able to represent the interests of his or herself – proceed to the Client Section of the Questionnaire.
What is the full name of the victim?*
First Middle Family Name (Include Maiden Name in brackets)
Please attach a copy of the victim’s Birth Certificate
Max. file size: 32 MB.
What is / was the age of the victim at the time of death / injury?
Please enter a number from 0 to 99.
What is the date of birth of the victim?
Month
Day
Year
Where was the victim born?
City / State / Province / Region Country
What is / was the gender of the victim?
Please attach a photograph of the victim
Max. file size: 32 MB.
What is / was the residential address of the victim at the time of the event?
Street Address Suburb / District Town / City State / Province / Region ZIP / Postal Code Country

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PRIVATE AND CONFIDENTIAL