F.S.L.C. FILE #_________________________

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250 Yonge Street, Suite #2201
Toronto, ON M5B 2L7
PHONE: 647-574-1795
OFFICE@FirstStopLegalCentre.ca

ELIGIBILITY APPLICATION FORM
Please Return Your Completed Free Legal Application Form in Person, by Courier or by E-mail. Please,
also keep a copy of the application form for your personal records.

CLIENT(S) CONTACT INFORMATION

Surname:_________________________________________________________________________

Given Names:______________________________________________________________________        

      Full Address:___________________________________________________________________________
Country:____________________State / Province:___________________City:_____________________
Number of year(s) at this address__________Zip / Postal Code / Other__________________________
Cell phone:(____)____________Home Phone:(____)____________ Fax Number:(____) _____________
E-mail Address:________________________________________________________________________
Family Size:___________________________________________________________________________
Yearly Income:_________________________________________________________________________


Past or Present Employer / Social Benefits with full Address and Telephone Number:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________


F.S.L.C. FILE #___________________________

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Special Instructions about your Employer and / or your Source of Income:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
MATTERS / PARTIES Brief Description:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Opposing Party / Lawyer / Para-legal Information:
Surname:_____________________________ Given Names:____________________________________
Full Contact Address:___________________________________________________________________
______________________________________________________________________________________
Cell phone:(____)_____________Home Phone:(____)___________ Fax Number:(____) _____________
E-mail Address:________________________________________________________________________


Legal Remedy and / or Legal Step Required in Brief:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________


F.S.L.C. FILE #___________________________

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Please Note that F.S.L.C. Highly Recommends that if you live in North America,
Please Apply for The State; The Provincial; or The Territorial Legal Aid Services First.
Have you Applied for The Local Legal Aid Services First?  Yes________ No_________

PLEASE ATTACH COPIES IF APPLICABLE:
If Yes, Explain:__________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
If No, Explain:______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
I_________________________________________hereby give Full Consent to First Stop Legal Centre to
conduct a background check for my Application for the Sole Purpose of Representing my Legal
Interests Free of Charge and / or Receiving Free Legal Services in any proceedings that F.S.L.C.
deems necessary in their Sole Discretion and to Pursue or Finalize any settlement in my legal
claim(s) as I have indicated in this document herein.

______________________________________________________________________________
CLIENT PRINTED NAMES AND  DATE


______________________________________________________________________________
CLIENT SIGNATURE AND  DATE

F.S.L.C. FILE #____________________________


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APPLICATION FORM FINAL DISPOSITION
Reason Application Accepted:____________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Reason Application Declined:____________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

_______________________________________________________________________________________
OFFICIAL F.S.L.C. SIGNATURE AND DATE

 Alternatively, you may pick up hard copies from the office during business hours or you may request application forms from the Secretary Ms Pamela D.Sukoto in confidence  at the following E-mail  Address:

Pamela.Sukoto@firststoplegalcentre.ca