VERY IMPORTANT REMINDER:

All Application Forms Shall Be Down-loaded Online Or Requested By E-mail:

Pamela.Sukoto@firststoplegalcentre.ca

 F.S.L.C. FILE #_________________________

FREE LEGAL SERVICES AGREEMENT

Please Return Your Completed Free Legal Services Agreement in Person, by Courier or by E-Mail. Please,
also keep a copy of This Agreement for your Personal Records.

FIRST STOP LEGAL CENTRE

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

CLIENT(S) CONTACT INFORMATION

Surname:_________________________________________________________________________

Given Names:______________________________________________________________________        

      Full Address:_______________________________________________________________________
Country:____________________State / Province:___________________City:_____________________
Number of year(s) at this address__________Zip Code/ 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:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

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:
____________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Please Note that F.S.L.C. Highly Recommends that if you Live in North America or Continental Europe,
Please Apply for The State; The Provincial; or The Territorial Legal Aid Services in Your Jurisdiction First.

Have You Applied For Your 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 #____________________________

FREE LEGAL SERVICES APPLICATION FINAL DISPOSITION

Reason Application Accepted:_____________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Reason Application Declined:____________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
OFFICIAL F.S.L.C. SIGNATURE AND DATE

FREE  LEGAL SERVICES DISCLAIMER:

This Legal Services Agreement is Governed by The Laws of The Province of Ontario, in Canada. Therefore, Any Claims Arising out of this Agreement Shall be Made Only at The Head Office in The Province of Ontario, in Canada.