Bar Pro Bono UnitThe National Pro Bono Centre48 Chancery Lane, London, WC2A 1JFDX 188 London Chancery LaneEmail: enquiries@barprobono.org.uk

IndividualApplication form

If you are from an organisation who wishes to apply please use the Organisation Application Form.

PLEASE READ THESE NOTES BEFORE APPLYING TO THE BAR PRO BONO UNITWe can only assist if public funding cannot be obtained and if the Applicant is unable to pay privately.

We need a minimum of 3 weeks’ notice of any hearing date or deadline from the date all information needed isreceived unless there are exceptional circumstances.

We can usually only help where an individual piece of work will take 3 days or less including preparation time.

Assistance is not guaranteed. Conduct of the case remains the Applicant’s responsibility at all times.

How to apply

1. All applications must be made through a referral agency such as a barrister, solicitor, appropriate adviceagency, Citizens Advice Bureau, Law Centre or your local MP

2. Complete all sections of this application form and ensure it is signed by your client or by you, as the referringorganisation.

3. Send the following to the Unit by post or DX (not fax or email). Applications must be submitted in hard copyand always send photocopies not original documents – we cannot accept responsibility for originaldocuments. The documents above must be supplied for a decision to be made as to whether we can assist.Please tick to show what you have included:

Copies of key case documents. If there are a lot of documents, please ensure as a minimum that thefollowing are supplied at this stage. (The Unit must see the documents in bold)

Any court / tribunal papers, including court orders and judgments

Any letters or opinions from solicitors, barristers or advisers giving advice about the case

Key correspondence with any other person(s) involved, or their solicitors

Where help is requested with an appeal, a copy of the judgment being appealed

Where advice is required about a contract or formal document, a full copy of the contract /document

Any other key documents (Please check overleaf for further information regarding documents thatmust be included with this application form).

Are there any further relevant documents in existence not supplied with the application? Yes No

Please include on a separate sheet a list of what else is available

4. We aim to acknowledge all applications within 7 days.

PLEASE NOTE: Any documents supplied will be destroyed 8 weeks after closure of a file unless it is indicatedthat the applicant wishes to recover papers from the Unit. Any such indication must be made at the time of makingthe application or submitting any further documents. Papers can be recovered by the applicant or an adviser tothe applicant in person, by supplying a DX number, or by sending a cheque for postage. Papers must be recoveredwithin 8 weeks of the closure of a case by the Unit unless special arrangements are made with the Unit before thistime.

www.barprobono.org.uk 020 7092 3960

Further informationSufficient documents should be included with an application for us to make a decision as to whether to assist a caseor not.

If there are more than 100 pages of papers please make a selection of what seems the most important; andprovide a summary of what other documents exist.

Always put documents in date order

Please provide a list at the front

We regrettably cannot accept applications or further information by email or fax.

There are further information sheets available from us specifying the documentation which needs to be provided forthe following types of case:

Criminal

Planning

Family (children and ancillary relief)

Employment

Immigration

These forms are available to download on www.barprobono.org.uk, or by contacting us.

It is not unusual for us to be approached for assistance by both sides in a case. If so,for confidentiality reasons you will not be notified, but the requests will be dealt bydifferent caseworkers1. Referring organisation detailsAgency / firm* name (*delete):

Address:

Postcode:

DX:

Public tel: Fax:

Contact name:

Contact position:

Signature:

Direct line tel (this will NOT bemade available to the client):

Mobile tel:

Email:

2. Client detailsName:

Address:

Postcode:

Tel (day): Tel (evening): Tel (mob):

Email: Fax:

3. Courts and tribunalsHave proceedings been started in a court or tribunal in the case?: Y Please give details below

N Go straight to Question 5Court / tribunal name:

Address:

Postcode:

Court case number:

Names of case (eg Smith v Ali):

Details of other party: And their solicitor (if known)

Name: Name:

Address: Address:

Telephone: Telephone:

Fax: Fax:

Email: Email:

If there is more than one party please provide full details on a separate sheet. It is not unusual for us to beapproached for assistance by both sides in a case. If so, for confidentiality reasons you will not be notified, but therequests will be dealt by different caseworkers

4. Hearings – give details of all future court / tribunal hearingsHearing description Is hearing

listed yet?Length (if not yetlisted, giveestimate)

Date(s) Time (eg10am)

Y N

Y N

Y N

Y N

5. Other deadlines – give details of any case deadline not already mentioned in Question 4Date What needs to be done by the deadline

6. Case summaryPlease give us a summary of the case facts and issues. Continue on a separate sheet if necessary.This is a very important section. Please include all key dates and give details of any past court hearings.It is not enough just to write ‘Please see attached papers’.

7. Type of assistance requiredWhat assistance is requested from the Bar Pro Bono Unit?Please explain if you need help by a particular date, especially any dates set out at Question 4 and 5.

8. Referring organisation assistance

What help is being given to the client by the referring organisation (named at Question 1)?Ongoing assistance Help with filling in the application formOther (please give details below)

On what basis is help being given to the client by the referring organisation?Voluntary / charitable organisation Pro bonoPublicly funded (Legal Help / ‘green form’) Publicly funded (full certificate)Privately funded (please give details below*) Conditional / contingency fee*Other (please give details below) * (please provide a copy of the agreement)

If the case is accepted for assistance by us, would the referring organisation be able to assist with the following ifnecessary? (please tick all which apply)

Attending meetings with a barrister and client Completing court documentsTaking witness statements Preparing bundles for courtCorresponding with other parties Attending court with a barrister and clientNegotiation with other parties Other (please give details below)

9. Other advice agency and solicitor assistanceIs assistance currently being given by any other advice agency or solicitor not already mentioned?Has assistance been given in the past in the case by any other advice agency or solicitor?

Y NY N

If you have answered ‘No’ to both these questions, go straight to question 10.Otherwise, please give details of all advice agencies and solicitors who have been involved in the case below,completing the details on a separate page if there has been more than one agency or firm involved with the case.

Agency / firm* name (*delete):

Contact name:

Address:

Postcode:

DX:

Tel: Direct line:

Email:

Dates of involvement From: To:

On what basis did they assist you:Voluntary / charitable organisation Pro bonoPublicly funded (Legal Help / ‘green form’) Publicly funded (full certificate)Conditional / contingency fee (No Win No Fee)* Privately funded*Other (please give details below)

* If the Solicitors have acted on a Conditional/Contingency Fee or Privately Funded basis, please supply the Unit witha copy of your agreement.If you have had previous legal assistance, please supply copies of any advice provided.

If the firm / agency is no longer involved, please give reasons why not:

Financial information (Questions 10 – 17)Please ensure that every section is completed fully. Leave no sections blank. If any section does not apply,please write ‘N/A’ or ‘0’. Incomplete sections will delay your application.

10. Public funding (‘legal aid’)

I confirm that public funding (‘legal aid’) cannot be obtained in this case.

Please give reasons why public funding cannot be obtained. . Please provide copies of any correspondence withand decisions from the LSC (Legal Services Commission). The LSC can be contacted via their Community LegalAdvice Website: www.communitylegaladvice.org.uk.

Has public funding previously been available in the case? Y (give details below) N (go to question 11)

Dates: From: To:

Why was it withdrawn? Please supply reasons.

11. Other resources – please include all relevant documentation

Is the applicant a member of a Union or similar organisation (eg medicaldefence organisation)?

Y N

Does your home contents insurance include cover for legal expenses? Pleasecheck with your insurance provider if you are not sure.

Y N

Have any of the following been approached for assistance?

Y N Free Representation Unit (FRU)

Y N LawWorks

Y N Other charities / advice agencies not mentioned already in the form

If you have approached any of the above organisations in this section, please give details in each case of anyapproach made for help, the date of the approach, and what the response was (please continue on a separatesheet if necessary):

12. Receipt of benefits

Does the applicant receive any of the benefits listed in this box?

Yes Please tick all which apply and give the monthly amount.

No

Income Support £ (monthly) NASS Support £ (monthly)

Jobseekers Allowance(Income Based)

£ (monthly) Pension Credit(Guaranteed)

£ (monthly)

13. Evidence of benefits

Yes, I have current proof Please specify what proof you have:

Please send a copy of the current proof of the benefits and amounts given at question 12.

No, I do not have current proof

For questions 14 to 18, please give all relevant financial details in the boxes provided, including those for anyfamily members to whom the applicant might reasonably look for help. Continue on a separate sheet ifnecessary. Please put ‘0’ where applicable.

14. Savings, investments and other major assetsPlease give details of any savings, investments and other major assets the applicant or the applicant’s partnerhave, including money in deposit accounts, shares owned, cars and other significant material assets etc.

Type of saving, investment or asset Value (£)

15. DebtsGive details of any debt which the applicant has which is still outstanding, including the amount owed. Set outthose debts for which the applicant is currently making repayments and other debts where the applicant is notcurrently making repayments.

Creditor Sum still owed (£) Monthly repayment if any (£)

16. PropertyDoes the applicant or the applicant’s partner own any property (including a home)? Y NPlease list each property below and continue on a separate sheet if necessary.Please refer to Section 11 about home and contents insuranceAddress of property (if not the applicant’s own home,please give further details)

Approximate currentmarket value (£)

Mortgage outstanding (£)

17. Income (monthly) Please put ‘0’ in any box where there is no income from that source

Salary (gross) £ Benefits (any not alreadygiven at question 12)

£

Bonuses £ Rental income £

Partner’s salary £ Other (please specify):

Pension £ £

Income from savings/investments

£ £

Maintenance £ £

Total monthly grossincome :

£

Please continue to section 18

18. Expenditure (monthly) Please put ‘0’ in any box where there is no expenditure on that item

Rent £ Credit cards / hire purchase £

Mortgage £ Leisure £

Council tax £ Other (please specify):

Home insurance £ £

Household bills £ £

Food / clothing £ £

Transport £ £

Loan repayments £ £

Total monthly expenditure: £

Number of Dependents (please specify):

19. Further informationPlease set out below any further information as to why you feel unable to pay for legal assistance (if applicable)

Data Protection NoticeThe Bar Pro Bono Unit will process information about the applicant and the applicant’s case to assess, administer and reviewthe application, and any future application. Processing may include disclosing information to and receiving information fromthird parties such as advice agencies, voluntary organisations, courts, the Legal Services Commission, legal expense insurers,trade unions and legal advisers where necessary under suitable obligations of confidence. We will receive a report of theresults achieved in the applicant’s case from the barrister provided including a record of any advice or hearing. Unless we areasked not to, we may also produce an anonymised report of the case, for example, in the Bar Pro Bono Unit newsletter. In therare instances where both sides of a matter apply to the Unit for assistance, both sides will be informed in writing that the Unithas also received an application for assistance for the other party. By making this application you confirm that you consent tothe above processing of your information.

In some cases we may want to discuss details of your case with LawWorks, ILEX Pro Bono Forum, theEmployment Lawyers Association, or another charity giving pro bono help. Please tick the box if you would preferus not to discuss the case with them.

Statement of truthI certify that the information in this application is to the best of my knowledge true, accurate andcomplete, and understand that any decision to refer a case to a volunteer barrister for assistance is takenon that basis. I understand that assistance is not guaranteed at any stage.

Signature: Dated:

Name (block capitals):

If not the applicant, relationship to the applicant:

When filling in this form on behalf of your client, please read the Data Protection Notice and Statement oftruth to them. Signing or making the application for someone else signifies their consent.

Equal OpportunitiesThe Bar Pro Bono Unit aims to assist in cases irrespective of age, race, gender, sexual orientation, disability,physical appearance, creed, religion and political persuasion.

In order to help us monitor the effectiveness of our equal opportunities policy, we ask all applicants to provide theinformation indicated below. This information will only be used for monitoring and statistical purposes

This section will be detached from the application form, and will not be accessible by our volunteer casereviewers or panel members.

Ethnic origin

I would describe my ethnic origin as:

A) White BritishEnglishScottishWelshNorthern Irish

White OtherIrishOther White: ______________

B) MixedWhite & Black CaribbeanWhite & Black AfricanWhite & AsianMixed BritishOther Mixed: ____________

C) AsianIndianPakistaniBangladeshiChineseBritishOther Asian: _____________

D) BlackCaribbeanAfricanBritishOther Black: _______________

E) OtherAny other ethnic background,

please describe: ______________

F) Would prefer not to indicate

Age and gender

Age at date of application:……………………….. Would prefer not to indicate

Gender:

Male Female Would prefer not to indicate

Disability

Do you consider yourself to have a disability? Yes No Would prefer not to indicate

If yes, please tick any of the list below which apply.

DyslexicBlind / partially sightedDeaf / hearing impairmentWheelchair use / mobility

difficulties

Need personal careMental health difficultiesUnseen disability (eg asthma,

diabetes, epilepsy

Multiple difficultiesOther:

____________________________Would prefer not to indicate

Source of information about the Bar Pro Bono Unit

Where did you hear about the Bar Pro Bono Unit?

Law CentreRCJ Citizens Advice BureauOther Citizens Advice BureauOther advice agency:

____________________________Free Representation Unit (FRU)

LawWorksSolicitorBarristerCourt / TribunalBar CouncilMedia / Press

Bar Pro Bono Unit websiteOther website :

_____________________________Made a previous applicationOther (please specify):

_____________________________