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Schedule 1

FORMS

FORM 1

(Regulation 3)

CONFIDENTIALITY AND OATH OF SECRECY

SAINT LUCIA LEGAL AID AUTHORITY

I, make oath/solemnly affirm/declare

that I will faithfully and honestly fulfil my duties as a member, officer or employee of the Authority in conformity with the Legal Aid Act, Cap. 2.17 and that I will not, without due authority in that behalf, in any manner whatsoever, communicate any confidential matter coming to my knowledge by reason of my duties as a member, officer or employee of the Authority.

FORM 2

(Regulations 4, 5 and 6)

APPLICATION FOR LEGAL AID

To the Executive Director for Legal Aid:

1. I, of ,

(name in block letters) (permanent address in block letters)

born on the day of , 20 ,

(occupation)

apply for legal aid for the following purpose:

Please describe above briefly and clearly:

(a) the kind of claim to be made or resisted,

civil

Criminal

(b) whether Court proceedings have begun or an appeal is involved,

2. My opponent is of

(name of opponent in block letters)

(address of opponent)

3. The attorney-at-law I wish to act for me is

(name of attorney in block letters)

of .

(address of attorney-at-law)

4. Have you previously applied for legal aid?

Yes

5. If you have previously applied for legal aid, please state the nature of the matter and the result, if any.

6. Has any attempt been made to settle the matter out of Court?

Yes

If yes, please give details and enclose any correspondence

7. I understand that if legal aid is granted I may be required to make a contribution towards my costs but I shall have an opportunity to consider the terms on which legal aid will be given before making up my mind to accept.

8. I undertake to supply any further information needed by the Board in connection with my case.

9. Address where you can be contacted if you do not want to use the address above:

10. The following is a statement of my financial circumstances:

(a) General Information of applicant:

Full name:

Address:

Date of Birth:

Occupation:

Status:

Single

Married

Divorced

Note: If you are married, you must state the income of your spouse, unless he or she is your opponent in the case or you are living apart.

INCOME OF APPLICANT

(Please indicate what you receive after deduction of income tax and National Insurance contributions and state all sources of income below.)

Income of Applicant

Amount (EC$)

What was your income for the last 12 months?

(b) General Information of spouse:

Full name:

Address:

Date of Birth:

Occupation:

INCOME OF SPOUSE:

My spouse is my opponent

I live apart from my spouse

Income of spouse

Amount (EC$)

What was the income of your spouse for the last 12 months?

Please indicate any other source of income and the amount:

Source of income

Amount (EC$)

pension

state benefits

rental income from another property

maintenance payments for children

any other money

DEDUCTIONS

1. How many persons are dependent on applicant? x

2000

2. How many persons are dependent on your spouse? x

2000

3. Personal expenses $3,000.00

4. Are there any persons under the age of 18 years, not being members of your household, who you are supporting pursuant to a Court Order or otherwise (give name, age of such persons and specify the amounts actually paid annually for such support).

5. Rent if any (subject to maximum of $1,000.00 per annum).

(Expenditure relating to repairs/insurance included)

Total Deductions $

Total Income – Total Deductions = Total Disposable Income

CAPITAL OF APPLICANT

1. Do you own any property besides a dwelling house owned and exclusively used by you and your family as your home assessed at an annual value of not more than $10 000.00?

Yes

2. If yes, what is the annual value of that property? $

3. If you own any motor vehicle, what is its value? $

4. What amount do you have by way of savings in a personal or joint account in the following institutions?

(a) Banks: $

(b) Credit unions: $

5. If you own any other assets (for example shares, boat, real estate but excluding any dwellings specified in 1 above and your wearing apparel, tools of trade and household furniture and effects) please specify what asset and the value of that asset.

Assets

Value

(a)

(b)

(c)

(d)

Total value of assets:

6. If you own any insurance policy, what is the total surrender value?

Total Disposable Capital: $

STATEMENT OF LIABILITIES

1. Do you have any liabilities?

Yes

2. If yes, state below (list all liabilities e.g. outstanding mortgages, loans and any other debts).

Item

Balance Owing

Total liabilities: $

Declaration of Applicant

I declare that the information I have given on this form is correct and complete.

I understand that if the information is not correct or complete, criminal or civil action may be taken against me.

I give permission for the Legal Aid Board to make any enquiries of third parties and I authorize the third parties to give any information necessary to deal with this application.

Signature

Date

CHILD OR VULNERABLE PERSON

Please read carefully before completing this part.

This part must be signed by the next friend applying on behalf of the child or vulnerable person (applicant).

1. Name of next friend

2. Address for correspondence of next friend

3. Relationship to the applicant:

4. If you are applying on behalf of a child, does this child receive any money on a regular basis?

Yes

If yes, please specify the amount $

(Do not include part-time earnings, holiday jobs, pocket money or any maintenance that you get for the child.)

5. Does this child have any savings, items of value or investments totalling $2,500.00 or more or is he or she due to receive money from a trust fund or will?

Yes

If yes, please specify the amount $

Declaration by next friend

To be signed only by the next friend on behalf of a child or vulnerable person.

I declare that as far as I know, the information I have given is true, based upon the reasonable enquiries which I have been able to make, exercising due care and diligence.

(signature of next friend)

Date

REPRESENTATIVE, FIDUCIARY OR OFFICIAL CAPACITY

Please read carefully before completing this part.

This part must be signed by the person applying in a representative, fiduciary or official capacity on behalf of an aided person.

1. Name of representative/fiduciary/official:

2. Address for correspondence of representative/fiduciary/official

3. Relationship to the applicant:

4. If you are applying on behalf of a person, does this person receive any money on a regular basis?

Yes

If yes, please specify the amount $

5. Does this person have any savings, items of value or investments totalling $2,500.00 or more or is he or she due to receive money from a trust fund or will?

Yes

If yes, please specify the amount $

Declaration by a person acting in a representative, fiduciary or official capacity

To be signed only by a person applying in a representative, fiduciary or official capacity on behalf of an aided person.

I declare that as far as I know, the information I have given is true, based upon the reasonable enquiries which I have been able to make, exercising due care and diligence.

Signature

Date

(signature of representative/
fiduciary/official)

This application form must be submitted to the Executive Director with all supporting documents attached and the application fee in order to facilitate the processing of your application.

If this form must be completed. Failure to complete this form may result in the form being returned to you which could result in a delay in processing your application.

FORM 3

(Regulation 18)

ACCEPTANCE OF OFFER FOR LEGAL AID

I, of
(name of applicant) (address of applicant)
understand that the Saint Lucia Legal Aid Authority is prepared to issue a legal aid certificate to me on the terms set out hereafter.
I accept this offer and agree to comply with its terms and conditions. I enclose $ .............................. as required under section.

(signature of applicant)	(Date)
TERMS AND CONDITIONS
1. The scope of my legal aid certificate will be defined as follows:




(describe the proceedings or matter in relation to which legal aid is granted)
2. The attorney-at-law acting for me will be
(name of attorney-at-law)
of
(address)
3. I am required to make an actual contribution of $
towards the cost of my case payable as follows:

FORM 4

(Regulation 19)

AUTHORIZATION FORM

SAINT LUCIA LEGAL AID AUTHORITY

The Saint Lucia Legal Aid Authority hereby authorizes
(name of attorney-at-law)
of to give legal advice and consultation to
(address)
of
(name of aided person) (address of aided person)
The above-named attorney-at-law will be entitled to claim his or her consultation fee as prescribed under Schedule 4 of the Legal Aid Regulations.
To claim payment, an attorney-at-law must submit his or her account of fees and expenses in the structure set out in Schedule 4 of the Legal Aid Regulations.

I	agree /		disagree to provide legal advice
(name of attorney-at-law)
and consultation to of
(name of aided person)

(address of aided person)

(Signature of attorney-at-law)		(Date)

FORM 5

(Regulation 20)

LEGAL AID CERTIFICATE

SAINT LUCIA LEGAL AID AUTHORITY

This is to certify that of
(name)

(address)
(hereinafter referred to as “the aided person”) is entitled, in accordance with the Legal Aid Act, Cap. 2.17 to legal aid for:



It is further certified that:
The disposable capital, disposable income and maximum contribution have been determined as follows:
Disposable capital:
Disposable income:
Contribution:
Payable by	lump sum or instalments of for .
Where applicable:
(name of next friend)
ENDORSEMENT
The aided person's attorney-at-law is of
(name of attorney-at-law)
.
(address)
Issued this day of , 20 .

Executive Director		Chairperson
Saint Lucia Legal Aid Authority		Saint Lucia Legal Aid Authority

FORM 6

(Regulation 21)

STATUS REPORT

SAINT LUCIA LEGAL AID AUTHORITY

Name of attorney-at-law:
Name of aided person:
Date case assigned:
Action Taken:
Further action to be taken other than advice:
Notes and Comments:

(Signature of attorney-at-law)(	Date)

FORM 7

(Regulation 25)

REGISTER OF AIDED PERSONS

SAINT LUCIA LEGAL AID AUTHORITY

Name of aided person	Address of aided person	Nature of legal services	Case Ref No.	Date approved	Amount approved	Amount paid / cheque number	To whom paid

FORM 8

(Regulation 26)

FORM OF CHANGE OF CIRCUMSTANCES

SAINT LUCIA LEGAL AID AUTHORITY

Aided person's details
Case reference number:
Title: Initials: Surname:
Surname at birth:
(if different)
Date of birth: / /
Aided person's new details
Title: Initials: Surname:
First name(s):

Current address:


Daytime phone number:
Has the client's financial means changed? Please include change of address.
		Yes	No
	If yes, please complete the
Certification
Date change effective from: / /
I certify that the information provided is correct.
Signed: Date: / /
(authorized representative of the Board)
Name:
Case reference number: