Gamsa Law Application Form
Personal Details
Full Name
*
Mr.
Mrs.
Prefix
First Name
Last Name
Email
*
example@gmail.com
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do You have an Alternative Address Required by The Court?
*
Yes
No
Alternative Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Marriage Status
*
Please Select
Single
Married
Divorced
Do You Have Children?
*
Yes
No
How Many Children Do You Have?
*
What Are Their Ages?
*
Who Do The Children Reside With?
*
Eg: With Child's mother, With myself.
Schooling
Your personal level of education achieved
Highest level of School passed?
*
Secondary Education
Have You Completed Any Studies After School?
*
Yes
No
Tertiary Education
*
Any courses studied after Secondary School
Occupation
Your employment details
Are you Employed?
*
Yes
No
Where are You Employed
*
How Long Have You Been Employed At This Company?
*
Do You Have Any Relevant Health Conditions For the Court to Consider?
*
Yes
No
Please Describe the Relevant Health Condition.
*
Your Previous Record
Any relevant prior interactions you may have had with the court.
Do You Have Any Previous Convictions
*
Yes
No
How many Previous Convictions Do You Have?
*
Please Select
0
1
2
3
4
5
6
7
8
9
10
More than 10
How many times you have been found guilty for a criminal offence by a Court of Law.
Which Offence Have You been Found Guilty of with the Relevant Year You Were Found Guilty in.
*
Eg: Theft - 2015, DUI - 2021
Do You Have Any Pending Matters in any Criminal Court?
*
Yes
No
Which Other Pending Matter Do You Have And in Which Court Are you Appearing in For That Matter?
*
Eg: Assualt - Wynberg, Theft - Bellville
Do You Have Any Outstanding Warrants For Your Arrest?
*
Yes
No
In Which Court is The Warrant For Your Arrest?
*
Information Regarding The Current Charge Against You
Relevant information of the current charge which you need assistance with
What is the Offence You Are Currently Being Charged With?
*
Eg: Theft, Assault, DUI.
Which Court Are You Appearing In for This Charge?
*
Eg: Bellville Regional Court, Simons Town Magistrates' Court, Mitchells Plain Magistrates' Court
Do You Have The Next Date On Which To Appear In This Court?
*
Yes
No
On Which Date Will You Be Appearing In This Court For This Matter?
*
-
Month
-
Day
Year
Date
What Is Your Custody Status On This Matter?
*
Please Select
On Warning
On Bail
In Custody
Please Upload Any Relevant Documentation Which You May Feel Is Important For Your Attorney To Have With Regards To This Matter.
Browse Files
Drag and drop files here
Choose a file
Eg: Copy of ID, Proof of Address.
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Signature
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