VERY IMPORTANT REMINDER:

Please note that you may pick up Hard Copies from the Office during Business Hours. Please, also note that all Non-profit businesses must request the  Application Forms from the Secretary Ms Pamela D.Sukoto in confidence  at the following E-mail Address:

Pamela.Sukoto@firststoplegalcentre.ca

 F.S.L.C. FILE #_________________________

Page 1 of 4
250 Yonge Street, Suite #2201
Toronto, ON M5B 2L7
PHONE: 647-574-1795
Office@FirstStopLegalCentre.ca

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.

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 #___________________________

Page 2 of 4
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 #___________________________

Page 3 of 4
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 #____________________________

Page 4 of 4

FREE LEGAL SERVICES APPLICATION FINAL DISPOSITION

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

DISCLAIMER:

This 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.