SCLSC-4A
Supreme Court Legal Services Committee
APPLICATION FOR LEGAL SERVICES
The
Secretary,
Supreme
Court Legal Services Committee,
Supreme
Court Compound, New Delhi-110001
1.Name(In
Block Letters) ...............................................................................................................
2.Father’s
Name /Husband’s Name
..............................................................................................................
3.Address:
(a)
Residential : .............................................................................................................
(b)Occupational
:
.............................................................................................................
4.(a) Age
and Date of Birth : .............................................................................................................
(b)Education
:
................................................................................................................
5.Status :
...........................................................................................................................
6.Number
of dependants & their relation to the Applicant
.....................................................................................................
7.Any
other financial liabilities :
.............................................................................................
8.Income
per Month(Attach Income Certificatefroma Revenue Officer)
............................................................................................................
9.Occupation
:
....................................................................................................................
10.Other
sources of Income, if any :
..........................................................................................
11.Sources
and monthly income of memberof the family
....................................................................................................................
12.Details
and value of moveable & immovable assets held by the applicant, his
dependent and other members of his family
.......................................................................................................
13.Any
other relevant information :
..........................................................................................
14.Nature
of legal services and
advicesought.....................................................................................................................................
15.Whether
belongs to Scheduled Castes/Schedules Tribes/Child/Women(Please attach
certificate)
....................................................................................................
16.Whether
the matter in respect of which legal services and advice is being sought was
filed by you in person or through an advocate previously in the Supreme Court/
If so the result ......................................................................................................................................
17.Whether
Opinion of any advocate has been sought in the matter/if so the particulars of
the Advocate and his opinion.
Verified
that the information given above is true and correct.
(Signature)
Name : ....................................................................
Address: ....................................................................
Dated : ....................................................................
Place : ....................................................................