Client Registration Form - Individual

Please select the area of law that best relates to the services you require.

If you require assistance with filling out this form, please call 07 834 6000 or email [email protected]

Are you applying for Legal Aid?

Please request Legal Aid forms at your first appointment. If your application for Legal Aid is unsuccessful, all work carried out on your behalf will be billed to you at the appropriate rate.

Your First/Given Name

Your Middle Name/s

Your Last Name

Previous Name/s

Date of Birth

Phone Number

Email Address

IRD Number

Please advise if possible.

What is your citizenship?

Street Address (Line 1)

Street Address (Line 2)

Street Address (Town/City)

Street Address (Postcode)

Street Address (Country)

Postal Address (Line 1)

*if different from Street Address

Postal address (Line 2)

Postal Address (Town/City)

Postal Address (Postcode)

Postal Address (Country)

Billing Contact | First Name

If different from main contact.

Billing Contact | Last Name

Billing Contact | Email Address

First Name of contact person at NWM (if known)

Surname of contact person at NWM (if known)

How did you hear about us?

Referral Details E.g. Google, Facebook; Name of existing client or NWM staff member; Name of other company/professional.

Please select any newsletters you would like to receive:

*Ctrl+click for multiple choices

Name of person who filled out this form.

Agreement to terms.

By ticking this box and submitting this form, the person completing this form agrees that: 1) all of the information set out in this form is true, correct and complete; 2) they are authorised to legally bind the people and the businesses/entities described in this form; and 3) each of the people and businesses/entities described in this form agree to the Norris Ward McKinnon Terms and Conditions which are available at nwm.co.nz/client-information.

Date