JAFLAS Individual Application Form

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JAFLAS Legal Services and Help Centre Dr Alan M. Blacker The Lord Harley Email: clerksroom@lordharley.uk Tel: 0203 47 999 57

4 Margaret Clitherow Court Milk Street Rochdale OL11 1HF

1. Please complete this form like you mean it, we cannot imagine your details so please take time to fill this form out fully. We will reject your application for help if vital details are missing and you ought to have given them here.

2. We have no minimum notice period but it is in your own interest to give us as much notice as possible, we cannot be held responsible for missing deadlines whilst we are considering providing assistance.

3. Our assistance is not guaranteed and the conduct of the case remains your responsibility at all times.

We can receive personal applications but prefer it if you have received initial advice from welfare rights type organisations.

Applications can be submitted by post to address below or email. This is most important.

Please ensure you include the following documents including emails with your application;

Court / tribunal papers, including court orders and judgments and witness statements

Letters or opinions from solicitors, barristers or advisers giving advice about the case

Key correspondence with any other person(s) involved, or their solicitors

If seeking help with an appeal, a copy of the judgment being appealed

If seeking help about a contract or formal document, a full copy of the contract / document

Please send scanned copies in one file, so collate all your documents in the order above. Please note that we are unable to take responsibility for original documents.

Specific key documents to be provided with applications for assistance in criminal, planning, family (children and Financial Relief), employment and immigration matters are as above but pertinent to the case. If in doubt, attach the document in your single attachment.

We need sufficient documents in order to make a decision as to whether we can assist. If there are more than 100 pages of papers, please select what seems the most important and provide a summary of what other documents exist.

We aim to acknowledge all applications with 7 working days. Please put your documents in date order and provide a list of them at the front. Once received by us the documents remain our property for auditing and quality purposes.

We are disabled confident and will not discriminate on any personal attributes; other than honesty and complete transparency. We don't judge. We don't criticise.
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Please ensure you write clearly and complete each section thoroughly. If a question does not apply move on and leave it blank.
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Name
Title
First name
Surname
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Date of Birth* This field is required.
Date
Day
Month
Year
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Address
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Telephone number
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Email
example@example.com
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Please note, email is the preferred form of communication so please check your spam folder if you have one.
Section 2: Referrer details except where an individual has sought help and attaches it to the file
This section to be completed by the referrer unless you are making a personal application.
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Organisation name
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Address
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Postcode
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DX
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Email
example@example.com
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Direct Line
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(this will not be made available to the client)
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Contact name
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Contact position
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Signature
Clear
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How do you intend to assist the applicant?
Ongoing assistance (including corresponding and negotiating with other parties)
Help with filling in the application form only
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Date
Date
Day
Month
Year
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On what basis are you assisting the applicant? (e.g. pro bono, public funding. conditional/contingency fee (please provide a copy of the agreement) voluntary/charitable organisation, privately funded) Please provide a copy of any such agreement or dealings.
Section 3: Other Assistance You have Applied For Or Received
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1. Have you made any other applications for pro bono assistance?
Yes
No
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If yes, please specify which organisation(s) you have applied to together with details of the date of the approach, and what the response was (please continue on a separate sheet if necessary)
Date
Day
Month
Year
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Please note: The General Data Protection Regulation Notice at the end of this form states, amongst other things, that in signing this form you consent to us contacting other free advice organisations regarding your case, where it is appropriate.
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Yes
2. Are you currently receiving, or have you previously received, help from any other advice agency / solicitor I charity or union not already mentioned on this form?YesNo
Section 3: Other Assistance cont
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If yes, please give details below of all who have been involved in the case. Continue on a separate sheet if necessary.
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Organisation name
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Contact name
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Address
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Postcode
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DX
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Direct line
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Email
example@example.com
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Dates of involvement
Date
Month
Day
Year
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From
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On what basis did they assist you? Please tick below
Voluntary
Pro bono (free)
Publicly funded/legal help (please provide a copy of the agreement)
Conditional Fee (No win no fee) (please provide a copy of the agreement)
Privately (please provide a copy of the agreement)
Other.
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On what basis did they assist you?
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Section 4: Courts and tribunals
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1. Is a court or tribunal involved in your case
Yes
No
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Name of court or tribunal
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Forthcoming Hearing date
Date
Day
Month
Year
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Hearing length
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Please describe any special arrangements we need to make i.e. interpreter and which language, disabled access etc.
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2. Do you have deadlines relating to your case?
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Section 5: Details of the other party (if there is more than one party please provide more information on a separate sheet)
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Contact person
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Organisation
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Please let us have scanned copies of all correspondence received from them in date order starting with the last item received first.
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Section 6: How can we help you?
What assistance do you seek from our service?
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Tick below as appropriate* This field is required.
Advice
Drafting of documents
Representation at court/tribunal hearing
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Please give us a brief summary of your case including:

What you want us to help with, and A list of key dates/events up to the present in the order they happened. 1.This is a very important section. Please include all key dates and give details of any past court hearings. It is not enough just to write 'Please see attached papers'. 2. Please continue on a separate sheet if necessary. 3. Try and limit this document to 250 words. This will constitute your initial proof of evidence - your case and position. Misleading us here exposes you to severe consequences. Do this on the next page.
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Type a question
Huge
Large
Normal
Small
Ok
Ok
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Financial Information Incomplete sections will delay your application.

Please complete every section fully. If any section does not apply. please write "N/A" not applicable or 'O'.

Section 8: Public funding ("legal aid")
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Are you eligible for public funding?
Yes
No
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A. If you are not eligible, please explain why and provide copies of any correspondence decisions from the Legal Aid Agency declining funding. B. If you have not applied, please send copies of your current benefits and income.
Has public funding previously been available in the case? Yes
(give details below) No
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From
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Why was it withdrawn? (Please supply reasons)
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Reasons for its withdrawalPlease give as much detail as possible and send us the rejection or removal letter.
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Are you a member of a Union of similar organisation (e.g. Unison)
No
Yes
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Do you have legal expenses insurance (this includes any provisions made within home and contents insurance)?
Send us a copy of your household and other policies.
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Do you receive any of the benefits listed below? Please tick all which apply and give the monthly amount.
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Pension Credit
Universal Credit
Jobseekers Allowance
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Disability Living Allowance
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Other
Other
(monthly)
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If yes, please specify what proof you have below and provided a copy of the current proof of
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Do you have current proof of benefits received? If yes, please specify what proof you have below and provided a copy of the current proof of benefit. Also include details of benefits you are waiting to hear about
No
Yes
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For the questions below, please give all relevant financial details in the boxes provided, including those for any family members to whom you might reasonably look for help. Continue on a separate sheet if necessary. Please put '0' where applicable.
Section 11: Savings, investments and other major assets
Please give details of any savings, investments and other major assets you or your partner have, including money in deposit accounts, shares owned, cars and other significant assets etc.
Type of saving. investment or asset
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Details of investments and savingsPlease provide full details and up to date statements
Huge
Large
Normal
Small
Ok
Ok
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Give details of any outstanding debts, including the amount owed. Set out those debts for which you are currently making repayments and those where you are not currently making repayments.
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Do you or your partner own any property? If yes, please list each property below and continue on a separate sheet if necessary.
Yes
No
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Address of property (if not your own home, please give further details)

Approximate current market value (£)

Income from savings/investments

Number of adults in your home (over 18yrs)

Number of children in your home
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Details of property and details of family make upPlease provide full details and current mortgage or debt details. Please provide details of family members and their relationships. Please send us copies of proof of identification.
Huge
Large
Normal
Small
Ok
Ok
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Yes
Please set out below any further information which might help (if applicable) Are you gay, lesbian, bisexual, trans-sexual, homeless, ESOL, student or otherwise poor or vulnerable? YesNo If yes, please give details or ring the appropriate choice above.
Section 14: Further information
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Data Protection Notice
In some cases we may want to discuss details of your case with LawWorks, ILEX Pro Bono Forum, the Employment Lawyers Association, or another charity giving pro bono help. YesNo
JAFLAS will process information about the applicant and the applicant's case to assess, administer and review the application, and any future application. Processing may include disclosing information to and receiving information from third parties such as advice agencies, voluntary organisations, courts, the Legal Aid Agency, legal expense insurers, trade unions and legal advisers where necessary under suitable obligations of confidence. If a barrister is provided we will receive a report of the results achieved in the applicant's case including a record of any advice or hearing. Unless we are asked not to, we may also produce an anonymised report of the case, for example, in the publicity material we use to attract clients. By making this application you confirm that you consent to the above processing of your information.
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Data Protection Notice
No
In some cases we give feedback to your referrer, is this ok? Yes
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I certify that the information in this application is to the best of my knowledge true, accurate and complete, and understand that any decision to refer a case to a volunteer lawyer for assistance is taken on that basis. I understand that assistance is not guaranteed at any stage.
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Signature* This field is required.
Clear
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Date
Date
Month
Day
Year
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Name (block capitals)
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If not the applicant, relationship to the applicant
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For Referrer: When filling in this form on behalf of your client, please read the Data Protection Notice and Statement of Truth to them. Signing or making the application for someone else signifies their consent.
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You must provide copies of your driving licence and/or passport or at least one proof of address like a council tax bill. Please send both if you can.
Our postal Address: 4 Margaret Clitherow Court Milk Street Rochdale OL11 1HF
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JAFLAS aims to assist in cases irrespective of age, race, gender, sexual orientation, disability, physical appearance, creed, religion and political persuasion. In order to help us monitor the effectiveness of our equal opportunities policy, we ask all applicants to provide the information indicated below. This information will only be used for monitoring and statistical purposes. This section will be detached from the application form, and will not be accessible by our volunteer case reviewers or panel members.
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I would describe my ethnic origin as
A White British English Scottish
White & Black Caribbean
Indian
Welsh
White & Black African
Pakistani
Northern Irish
White & Asian
Bangladeshi Chinese
Other Mixed:
B Mixed
British
Other Asian:
Asian
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White other
Irish
Other white:
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D Black
Caribbean
F Would prefer not to indicate
African
British
Other Black:
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E Other
Any other ethnic background please describe:
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Other
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Any other ethnic background please describe:
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Age at date of application
Would prefer not to indicate
Male
Would prefer not to indicate
Gender: Female
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Age at date of application
Date
Month
Day
Year
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Disability
Yes
No
Do you consider yourself to have a disability
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If yes, please tick any of the list below which apply. Dyslexic
Wheelchair use / mobility
Would prefer not to indicate
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Wheelchair use / mobility
Need personal care
Multiple difficulties
Would prefer not to indicate
Blind / partially sighted
Mental health difficulties
Other:
Deaf / hearing impairment
Unseen disability (e.g. asthma, diabetes, epilepsy)
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Source of information about our help.
Where did you hear about our help?
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Media / Press
Law Centre
LawWorks
Bar Pro Bono Unit website
RCJ Citizens Advice Bureau
Solicitor
Other website:
Other Citizens Advice Bureau
Barrister
Other advice agency:
Court/ Tribunal
Made a previous application
Free Representation Unit
Bar Council
Other (please specify):
(FRU)
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Should be Empty: