Federal Court of Australia
Federal Circuit and Family Court of Australia	Application for		Give Details	
	Exemption from Paying		File Number:
	
	Court Fees - General

Federal Court and Federal Circuit and Family Court Regulations 2022		File name:
	
	Section 2.05		Date filed:
	
Cross boxes, for example , where applicable 			
					
Notice to applicant	
					
Use this form if:
•	you are receiving legal aid for your proceeding in the Federal Court or the Federal Circuit and Family Court from a State/Territory Legal Aid Office or an approved legal aid scheme or service (including an approved community legal centres); or
•	you are the primary cardholder of a Health Care Card, Pensioner Concession Card, Commonwealth Seniors Health Card or any other card that entitles you to Commonwealth health concessions (this does not extend to a dependant of the primary cardholder), or
•	you are an inmate of a prison or otherwise detained in a public institution, or
•	you are younger than 18, or
•	you are receiving youth allowance or Austudy payments or Abstudy benefits, or
•	you have been granted assistance under Part 11 of the Native Title Act 1993 for your proceeding in the Federal Court.
Information about approved legal aid schemes and services can be found on both Courts websites on their ‘fee exemption’ webpages.  If you are unsure whether the legal aid scheme or service you are receiving assistance from is approved, ask registry staff for assistance.
When returning your completed application form to the registry you will need to attach photocopies of documentary evidence of any of the above (such as your Health Care Card, Legal Aid or legal assistance provider letter or Native Title funding letter) to support your claim. Photocopy both sides of the card or other document if it has writing on both sides.  If more supporting information is required the Registry will contact you.
If you do not qualify for any of the above, you may be able to apply for individual fees to be exempted on the basis of financial hardship. Ask registry staff for the appropriate form and guidelines.
You must notify the Court Registry if there is any change to your circumstances that alter the information given in this application while the Court is dealing with your case.
	WARNING
Under the Criminal Code any person who knowingly makes an untrue representation or statement to obtain a benefit or advantage from the Commonwealth is guilty of an offence and, if found guilty, can be fined or imprisoned.
	
Details	
	
1	Name and address		family name (surname)
     		given names
     	
		
		     					 postcode                             tel      
Email                                           	
2	Court in which exemption is sought	   Federal Court				  Federal Circuit and Family Court
  Type:    All filing, setting down, hearing and other fees that may be payable in these proceedings	
3	Reason for seeking exemption	I currently hold or receive:
 Health Care Card				 Pensioner Concession Card 
 Commonwealth Seniors Health Card 
 Any other card that certifies entitlement to Commonwealth health concessions
 Youth allowance
 Austudy payments				 ABSTUDY benefits
Or:
 I am in receipt of legal aid or other approved legal assistance for these proceedings 
 I have been granted assistance for these proceedings in the Federal Court under Part 11 of the Native Title Act 1993
 I am younger than 18 years of age
 I am an inmate of a prison or otherwise detained in a public institution	
					
Signature	

date	/	/		
Court Use Only	
 Copy of relevant documents attached        Exemption granted (copy of this approval decision given/sent to applicant	/	/	)

Signature of officer                                                                                                                                     Date       /     /     	
	  Authorised by Principal Registrar FCFCOA/General Counsel FCA                01/04/2023