FJSS Application Form

Family Justice Support Scheme

Modest Means Legal Clearinghouse

The Modest Means Legal Clearinghouse assists Singapore Citizens and Permanent Residents who marginally fail the Legal Aid Bureau's means test. Under this scheme, a successful applicant will be referred to a maximum of 3 lawyers who agree to charge fees that are lower than their regular commercial rates in view of the applicant’s financial situation.
INSTRUCTIONS

When completing this application, you will be required to submit the following documents:
1. Identification document (NRIC)
2. Marriage certificate
3. Child's birth certificate (if any)
4. Court / other legal documents (if any) - e.g. court orders, court applications, letters/documents from spouse's lawyer etc.
5. Supporting documents for your case (if any) - e.g. photographs, medical report, police report, evidence of maintenance etc.
If you have these documents ready, this application form should take about 15 minutes to complete.

Family Justice Support Scheme

Pro Bono Legal Clearinghouse

The Pro Bono Legal Clearinghouse grants legal aid to eligible foreign spouses with Singaporean children in family justice matters.
INSTRUCTIONS

When completing this application, you will be required to submit the following documents:
1. Identification document (Passport, Employment Pass, Dependent's Pass, Long-Term Visit Pass)
2. Marriage certificate
3. Child's birth certificate
4. Court / other legal documents (if any) - e.g. court orders, court applications, letters/documents from spouse's lawyer etc.
5. Supporting documents for your case (if any) - e.g. photographs, medical report, police report, evidence of maintenance etc.
If you have these documents ready, this application form should take about 15 minutes to complete.

COLLECTION, USE AND DISCLOSURE OF PERSONAL DATA

Your personal data is collected for any or all of the following purposes:

(a) performing obligations in the course of or in connection with our provision of services in the form of legal advice and/or legal representation as requested by you;

(b) verifying your identity;

(c) responding to, handling, and processing queries, requests, applications, complaints, and feedback from you;

(d) managing your relationship with us;

(e) processing payment or credit transactions;

(f) complying with any applicable laws, regulations, codes of practice, guidelines, or rules, or to assist in law enforcement and investigations conducted by any governmental and/or regulatory authority;

(g) any other purposes for which you have provided the information;

(h) transmitting to any unaffiliated third parties including our third party service providers and agents, and relevant governmental and/or regulatory authorities, whether in Singapore or abroad, for the aforementioned purposes; and

(i) any other incidental business purposes related to or in connection with the above.

We may disclose your personal data

(a) where such disclosure is required for performing obligations in the course of or in connection with our provision of legal services in the form of legal advice and/or legal representation as requested by you; or

(b) to third party service providers, agents and other organisations we have engaged to perform any of the functions listed above for us.

The purposes listed in the above clauses may continue to apply even in situations where your relationship with us (for example, pursuant to a contract) has been terminated or altered in any way, for a reasonable period thereafter (including, where applicable, a period to enable us to enforce our rights under any contract with you).
WITHDRAWING CONSENT

The consent that you provide for the collection, use and disclosure of your personal data will remain valid until such time it is being withdrawn by you in writing. You may withdraw consent and request us to stop using and/or disclosing your personal data for any or all of the purposes listed above by submitting your request in writing or via email to our Data Protection Officer at this email address: DPO@probono.sg.

Upon receipt of your written request to withdraw your consent, we may require reasonable time (depending on the complexity of the request and its impact on our relationship with you) for your request to be processed and for us to notify you of the consequences of us acceding to the same, including any legal consequences which may affect your rights and liabilities to us. In general, we shall seek to process your request within ten (10) business days of receiving it.

Whilst we respect your decision to withdraw your consent, please note that depending on the nature and scope of your request, we may not be in a position to continue providing legal services in the form of legal advice and/or legal representation to you and we shall, in such circumstances, notify you before completing the processing of your request. Should you decide to cancel your withdrawal of consent, please inform us in writing via DPO@probono.sg. Please note that withdrawing consent does not affect our right to continue to collect, use and disclose personal data where such collection, use and disclose without consent is permitted or required under applicable laws.
Consent to the above PDPC policy*

In providing my personal data here, I agree that Pro Bono SG may collect, use and disclose my personal data in accordance with the purposes as stated above.

Legal Advice/ Legal Representation
Have you sought legal advice on this matter before?*

YesNo
Details of prior legal advice*
e.g. Attended legal clinic at State Courts on [date]
Are you currently represented by a lawyer?*

YesNo
Name of lawyer*
Do you intend to discharge your lawyer?*

YesNo
If you are already legally represented, why are you applying for assistance under FJSS?*
Have you ever been represented by a lawyer?*

YesNo
Name of previous lawyer*
Why are you no longer represented by the lawyer?*

Children
Number of Children*
Enter '0' if no children
Is your child / Are your children from this current marriage with the spouse listed above?*

YesNo
Name and Age of Child / Children*
Please indicate each child's age clearly (e.g. Sarah Tan, 7 years old; Brandon Tan, 10 years old)
Current Residential Address of Child / Children*
Please provide the address of each child clearly if living separately (e.g. Sarah Tan - Blk 123 Apple Road; Brandon Tan - Shelter (with applicant))
Please upload the birth certificate(s) of your child / children.*

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Areas of Assistance
1. Please ensure that you select and mention all areas of assistance required, e.g. divorce, protection orders, maintenance, children-related issues.

2. If you bring up an issue after a lawyer has been assigned, such matters will be assessed on a case-by-case basis.

3. Please note that if there are multiple issues involved (e.g. PPO, divorce, maintenance, custody), and/or if any additional matter arises after the assignment of a lawyer:

(a) There may be more than 1 lawyer handling your case (e.g. one lawyer handling the divorce, another lawyer handling the PPO application);

(b) There may be a change in lawyer if the existing assigned lawyer is unable to manage; and/or

(c) You may have to manage some applications on your own.
1. Please ensure that you select and mention all areas of assistance required, e.g. divorce, protection orders, maintenance, children-related issues.

2. If any additional issues arise after a lawyer has been referred/ engaged, the lawyer may quote additional fees for the expanded scope of assistance.
I understand and wish to proceed.

Spousal or Child Maintenance
Do you require assistance with maintenance?*

YesNo
Who is the maintenance application for?*

SelfChild(ren)Self and Child(ren)
Status of maintenance application*

Not filedPendingConcluded
Please provide the details of how each spouse has contributed to the household expenses and the children expenses.*
E.g. Applicant has paid school fees for all 3 children at a total of $100.00; Husband gives $300.00 for groceries and living eexpenses per month
Please upload any Court documents.

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Eg. Maintenance Order Cancelof
Amount of monthly maintenance for self*
Enter '0' if not applying for maintenance for self
Amount of monthly maintenance for children*
Enter TOTAL amount of maintenance applied for all children; enter '0' if not applying for maintenance for children
Breakdown of monthly maintenance for children
Please state how much maintenance you wish to apply / have applied for each child (E.g. Sarah Tan - $400; Brandon Tan - $200). Enter 'NA' if not applying for maintenance for children.
Any other comments

Division of Matrimonial Assets
Do you require assistance with division of matrimonial assets?*

YesNo
Please list out assets owned jointly or shared by both parties.*
e.g. matrimonial home, joint bank account etc. Enter 'NA' if none.
Please list out assets owned solely by you (Applicant).*
e.g. savings, investments, insurance policies, property (Singapore or overseas), company etc.
Please list out assets owned solely by your spouse (to the best of your knowledge).*
e.g. savings, investments, CPF money, insurance policies, property (Singapore or overseas), company etc.

Social Support & Other Information
Details of Family/Social support granted to applicant (if any)
Are you receiving help from an embassy?

YesNo
Additional Facts/Background information on applicant (if any)
Details of Case Worker
Referring Organisation
Case worker / Contact person
E-mail
example@example.com
Contact Number

Declaration & Conditions
The information provided by me in this application is true and complete to the best of my knowledge and I have not omitted to declare any material fact.

If it is discovered that I had knowingly made a false statement or representation in my application, I will face one/all of the following consequences:

1. I will be prohibited from receiving assistance from FJSS.

2. A police report may be made.
I understand and agree with the above.
Signature

Clear

Means-Test Declaration Form
Self-Assessment of Eligibility

Before you proceed, you may wish to preliminarily assess your eligibility for legal aid:
1. Average Monthly Per Capita Household Income (PCHI) must be S$950 or lower for the last 12 months prior to the date of application
2. Annual Value of applicant’s place of residence must be S$13,000 or lower
3. The applicant must not own any other property besides his or her place of residence
4. If Applicant is under 60 years old, Applicant’s savings and non-CPF investments must be S$10,000 or lower. If Applicant is 60 or above, Applicant’s savings and non-CPF investments must be S$40,000 or lower.

MEANS TEST

Part 1: Average Per Capita Gross Monthly Household Income (PCHI)
Are you employed (in Singapore or overseas)?*

YesNo
Have you been employed at all during the last 12 months? (in Singapore or overseas)?*

YesNo
Name of Employer*
Employment Commencement Date*

DayMonthYear
Spouse's Job Title*
Type 'unknown' if you do not know

Please upload your income documents for the past 15 months.*

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e.g. payslips, CPF documents, Income Tax Assessment/IR8A form etc. Cancelof
Do you have other sources of funds? (example: maintenance payments from spouse, allowance from parents or friends, rental income, CPF payouts)*

YesNo
Please state the types of funds and total amount of funds received in the last 12 months. *
For example: Maintenance from husband - $6,000 ($500 x 12), Rental income - $12,000 ($1,000 x 12)
Are you financially supporting someone who does not live with you?*

YesNo

MEANS TEST

Part 2: Property Information of Applicant
Do you own your place of residence?*

Yes, I have sole ownership of the propertyYes, my spouse has sole ownership of the propertyYes, my spouse and I have joint ownership of the propertyNo
Is your place of residence your matrimonial home?*

YesNo
Annual value of place of residence (S$)*
Annual value is the estimated gross annual rent of the property if it were to be rented out - e.g. rental of $500 per month x 12 = $6,000
Name(s) of other owner(s) of place of residence*
Enter 'NA' if you are the sole owner.
Please upload document(s) showing the annual value of your place of residence.*

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E.g. any property notices or letters in your IRAS MyTax Portal, document showing rental value Cancelof
Do you own any other properties (including overseas properties)?*

YesNo
Address, annual value of other properties*

MEANS TEST

Part 3: Capital and other assets
Do you have any bank accounts (in Singapore or overseas)?*

YesNo
Total amount in bank accounts (S$)*
Please upload your bank documents.*

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E.g. updated personal and/or joint account bank books or statements, Fixed Deposit receipts and/or any other bank-related information Cancelof
Do you have any cash savings?*

YesNo
Amount of cash savings? (S$)*
Do you have any insurance policies (e.g. Investment-Linked Policy)?*

YesNo
Please tell us the type of policy and cash/ surrender value.*
Please upload your insurance policy documents.*

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E.g. CDP account statement, fixed deposit account statement etc. Cancelof
Do you have any non-CPF investments (in Singapore or overseas)? This includes (1) Shares in your Central Depository (CDP) account; and (2) Any other financial/investment products with a cash value, such as fixed deposit accounts at financial institutions, and shares, bonds and exchange traded funds aside from those in your CDP account.*

YesNo
Please provide details of the investment products and their current values.*
Please upload your investment documents.*

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E.g. CDP account statement, fixed deposit account statement etc. Cancelof

MEANS TEST

Part 4: Income Information of Household Members
Please provide particulars of all household members.*
"Household members" refers to persons related by blood, marriage and/or legal adoption and have the same residential address reflected on the NRIC as the applicant for legal aid.

For salaried employees submit pay slips or CPF contribution history for the last 15 months. For self-employed persons, please submit IRAS statement for the latest assessment year.*

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MEANS TEST

Part 5/5: Other details
Are you or your child on any government financial assistance plan?*

YesNo
Please upload any documents pertaining to the financial assistance plan(s) listed above.*
Please upload any documents pertaining to the financial assistance plan(s) listed above.

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Are you suffering from any medical condition that requires long term medication/treatment or surgery?*

YesNo
Please state what your medical condition(s) are.*
Please upload any medical report, document or memo pertaining to the medical condition(s) you listed above.

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Do you have any outstanding conservancy, rental, utilities or medical bills, or any other outstanding legal liabilities?*

YesNo
Please elaborate on your liabilities. *
Please upload any evidence of your liabilities.

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DECLARATION AND CONDITIONS
Statement of Truth*

I believe that the facts declared in this application are true and complete. If it is discovered that I have knowingly made a false statement or representation in my application, I understand that (a) I will be prohibited from receiving assistance from Pro Bono SG and/ or (2) a police report may be made against me.
Signature

Clear
Should be Empty:

	Name of Employer	Job Title	Monthly Salary (S$)
Month 1
Month 2
Month 3
Month 4
Month 5
Month 6
Month 7
Month 8
Month 9
Month 10
Month 11
Month 12

	Relationship to Applicant	Total amount paid in the last 12 months (S$)
Dependent 1
Dependent 2
Dependent 3
Dependent 4
Dependent 5
Dependent 6
Dependent 7
Dependent 8
Dependent 9

	Full name	Relationship to applicant	Is this member employed?	Monthly income
Household member 1
Household member 2
Household member 3
Household member 4
Household member 5
Household member 6
Household member 7
Household member 8
Household member 9

Family Justice Support Scheme

Family Justice Support Scheme

Modest Means Legal Clearinghouse

Family Justice Support Scheme

Pro Bono Legal Clearinghouse

Personal Details of Applicant

Legal Advice/ Legal Representation

Details of Spouse/ Opposing Party

Marriage Information

Living Arrangements

Children

Areas of Assistance

Divorce

Personal Protection Orders

Spousal or Child Maintenance

Division of Matrimonial Assets

Children Issues

Social Support & Other Information

Details of Case Worker

Others

Declaration & Conditions

Means-Test Declaration Form

MEANS TEST

MEANS TEST

MEANS TEST

MEANS TEST

MEANS TEST

DECLARATION AND CONDITIONS