Form Legal Services

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Form Legal Services

  1. 1. LAA3 APPLICATION FOR LEGAL SERVICES THE LAW CENTRE WILL ASSIST YOU IN COMPLETING THIS FORM Name Address Telephone No. PPS. No Subject Matter (a) Family Law (b) Non-family (Tick as appropriate) Please provide details:- YOU SHOULD READ THE FOLLOWING DECLARATION CAREFULLY BEFORE YOU SIGN BELOW I have provided information about my means on this form and I apply for legal services for the matter(s) indicated above. I confirm that to the best of my knowledge the information which I have given on this application form is correct. I consent to the transmission to the Legal Aid Board of all information about my case which the Board may require. I understand that: - the Board may seek a report on my means from the Department of Social and Family Affairs; - giving incorrect information of failing to disclose information may lead to the withdrawal of legal services and that I may be liable for the cost incurred; - if my means change I must inform the law centre; - I may be liable for costs incurred by the Board in providing legal services and that my solicitor will explain this in greater detail. The value of my disposable capital assests does not exceed €4,000 or is as set out in the statement of capital. Signed: Date:
  2. 2. STATEMENT OF INCOME Type of Income Per Week Type of Allowance Amount per week Employment/Pension Accommodation Social welfare/state type Income tax Maintenance received PRSI Business/other occupation Child care (working parent) Other source Maintenance payment Benefit in kind e.g. a car Ages of dependent children Other Other dependants (specify) STATEMENT OF CAPITAL CAPITAL RESOURCES (OTHER THAN A PERSON’S HOME) e.g. car, other property Nature of resource Value Loans/Debts/Mortgages (other than a person’s home) Outstanding Balance Purpose Repayments OFFICE USE:

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