Application For A Practising Certificate Renewal And Solicitor Membership Of The Law Society Of New South Wales - 2015-2016 Page 3

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2015/16 Non-renewal
and Associate Membership
ABN: 98 696 304 966 ACN: 000 000 699
Form 001a (03-15)
18
Are you paying your associate membership fees by credit card?
Who should complete this section?
STOP
No
Please staple your cheque to the front page of this
Complete this section if you are not intending to
form.
renew your practising certificate (if you ticked “No” at
Q1).
Yes
Please provide your credit card details below.
Non-renewal and associate membership
E
Amount to
$
$264 Australian postal address
be charged:
12
Date of ceasing to practise in NSW
Card type:
AMEX
MasterCard
Visa
(dd/mm/yyyy)
Card
13
Are you (or were you) a principal in a practice?
number:
/
No
Go to Q16.
(mm/yy)
Expiry date:
Yes
Cardholder’s
name:
14
Has your law practice closed?
7
Cardholder’s
No
signature:
Yes
Who has the files?
19
I will not be practising as a solicitor in NSW with a NSW
practising certificate after 30 June 2015 and do not wish to renew
my practising certificate as at 1 July 2015.
Signature
15
Is there a successor to the practice?
7
No
W
Yes
hat is their name?
Date
(dd/mm/yyyy)
16
What is the main reason for not renewing your
practising certificate (optional)?
Associate Membership Fees
Fees for members with an Australian postal address
Please select
$264.00
17
If you are not renewing your practising certificate, you
Total amount payable
(inc $24.00 GST)
can apply to become an associate member. The
Fees for members with an overseas postal address
cost is $264 if you have an Australian postal address
Total amount payable
$270.00
and $270 if you have an overseas postal address.
Membership is from 1 July 2015 to
30 June 2016.
Do you want to apply for associate membership of
the Law Society?
No
Go to Q19 (Declaration).
Yes
You must print this document, sign it and return it.
Page 3

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