3.
(6) Stave
(60
abortly the
grounds relled
upon for
Lacing, defend-
Jag, Continuing
or being
party to the
(7) ON: DANCI
wood podnesu),
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The fact
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Dan Bement.
(9) You
should supply
with this
16
The grounds of my application are-
4.
The following persons can give evidence in support of my case-
and
5. I attach with this form the following documents-
קנין
FOTEN 13
(och a lettere.
comuneck,
deech, so ple
of will. x.)
which are
relevant to
FOOT CARE, And
supply a U
OF ALAD docu-
como the
source provided Jat,
mcrash the Bre
do a depoly deck of ULDET.
(10) If the
Director do
mot det for
FOO, POR KUN coiled to
velect You
own sollekter
And counsel,
If you do not
no refocu, cho
Dues hig
welcher or
៥. The solicitor and counsel (if counsel is assigned) whom I wish to act for
me in the proceedings are (10)
7. I understand that if my application is approved I shall be informed of the terms on which the Director is prepared to issue a Certificate, that those Condel for you. terms may include the payment by me of a contribution towards my costs of the proceedings, and I shill have the opportunity of accepting or refusing say offer of a certificate so made to me.
B I understand that I may be required by the Director to supply further
information in connexion with my application.
9. I have completed the statutory declaration herein.
Date
Signature of Applicant.
17
SPECIAL NOTICE TO APPLICANTS.
Section 23(1) of the Legal Aid Ordinance 1966 provides as follows-
"Any person seeking or receiving legal aid who-
(a) wilfully fails to comply with any regulations as to the information
to be supplied by him; or
(5) in furnishing any information required by such regulations know-
ingly makes any false statement or false representation, shall be guilty of an offence and Hable on summary conviction to a fine of five thousand dollars and to imprisonment for six mouths.".
STATUTORY DECLARATION BY APPLICANT,
1,00
of (6)
being the applicant in the within application do solemnly and sincerely declare that the replies to the undermentioned questions are true and correct to the best of my knowledge and belief.
A. State particulars and value of all properly of which you are possessed or to which you are entitled, exclusive of the sub- Peel matter of the proceedings referred to in the within application, your wearing apparel, your tools of trade, and the household furni- ture used by you in your home.
ALMANDPO
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** P***PRAYNAKLANACEAEngadaka
(a) Name La £14.
(2) Addre jud decuplulehti,
M
INCIUDA
lund, banquey
and other boldoen. dodržkách, Enca In bound or in broka. bubd.
Ing Beeleden
* Diber
Bel
сать тонне
lowed to or bald by Boy mber period; IOIDES DE J
dus from wAT person be
estave or SET Flipeu. Bol 154 parable under ang will. tram, Belli-
E 42: the
present valore
od may fe
WIDER KALTAMOS
policy abuseEN
PROT, bonda
of any body codile, Borsel,
Tehicle
BICHON OV, of
poods ar
chattal of
Buy Had
WoRoever. DO NOT INCLUDE che awelln
house in widel you bedde. Particulkan ot that should be piven under Periph C betare.