F.S.L.C. FILE #_______________________________
Page 1 of 4
250 Yonge Street, Suite #2201
Toronto, ON M5B 2L7
PHONE: 647-574-1795
FSLC@FirstStopLegalCentre.ca

ELIGIBILITY APPLICATION FORM FOR FREE LEGAL SERVICES
Please Return Your Completed 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 Ontario,
Canada, please apply for The Ontario Legal Aid First.
Have you Applied for The Ontario Legal Aid? 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:____________________________________________________________
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______________________________________________________________________________________
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______________________________________________________________________________________
Reason Application Declined:____________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
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______________________________________________________________________________________
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______________________________________________________________________________
OFFICIAL F.S.L.C. SIGNATURE AND DATE

 Alternatively, you can request all application forms from the Secretary Ms Pamela D.Sukoto in confidence  at the following E-mail  Address:

Pamela.Sukoto@firststoplegalcentre.ca