Application Acknowledgment Slip – Legal Aid Commission

Date Application Received(Required)

Type of ID Used

ID Card No.

Client ID (CCMS Only)

Title(Required)

Date of Birth(Required)

Enter full name(Required)

Residential Address(Required)

Street Address City/Town Postal Address

Contact Number

Office Application Received(Required)

Type of Matter(Required)

Where is the matter filed at?(Required)

Court

Other Organization

Application yet to be filed

Which court is your case in?(Required)

Where is the court?(Required)

Court Case Number(Required)

Island Court Location(Required)

Other Organization(Required)

Please specify?(Required)

Officer Name(Required)

First Last

Officer Designation(Required)

Office Contact(Required)

Email(Required)

Note

Acknowledgment Stamp and Officer Sign-Off