Likely Penalty Enquiry Form
It is likely that this form will only take you a few minutes to complete.
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 Contact Details |
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| Name: |
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| Contact Number: |
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| Email Address: |
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 Personal Details |
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| Age: |
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| Sex: |
Male:
Female:
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| No. of children: |
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| Occupation: |
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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? |
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| Why were you driving? |
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| What court do you have to attend? |
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| What date do you have to attend Court? |
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| Need for a licence |
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| Will you lose your job if you lose your licence |
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| What suburb do you live in |
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| What suburb do you work in |
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| 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? |
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| Do you? |
Pay Rent:
Pay board:
Have a mortgage:
Own your own home:
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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?
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Yes
No
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