FORM B APPLICATION FOR LEGAL AID OR ADVICE [See regulation 37 (1)] To The Member-Secretary/Secretary, ............Authority/Committee Sir, I, Shri/Shrimati ..........................., aged about ....... years son / daughter / wife of .............. , at present residing at ....................... , beg to apply for legal aid / advice under the following circumstances, namely :- 1.I am employed / not employed: ........................... (a)Occupation .................................... (Nature of employment, service, trade, business, etc.) (b)Whether employed in Army, Navy or Air Force or Police Force or retired there from .................................. (c)Period of employment and date of retirement ......... (d)Total monthly income from all sources is .............. 2.My monthly income from all sources is ................... 3.(a) My residential premises are rented in my name alone / jointly in the names of .............................. (b) The value / monthly rent thereof is ;.................. 4.I have owned land measuring....... in total under Dag No...... of patta No.... of Village / Town ..........Mauza .........P.S. ........ District ........paying revenue of Rs....... per annum (details of the land particulars shall be furnished). (a)The value of the produces of the land is Rs. .................. (b)My total annual income from the land and other properties is Rs..... 5.My other sources of income are ................. (Detail particulars shall be furnished.) 6.My other assets, properties and effects and their value are Rs....... (Details particulars shall be furnished.) 7.I have / have not disposed of any of my properties, assets or effects within a period of six months prior to the date of this application by way of sale, gift, mortgage or otherwise. (If anything has been disposed of details thereof, including the consideration, shall be furnished). 8.The total number of my family members is.......... and they are as shown below,- NamesAgeRelationshipOccupationAnnual income with the applicantIf any)(If any) 1................................................................................................................ 2................................................................................................................ 3................................................................................................................ 4................................................................................................................ 5................................................................................................................ 9.The number of dependent member in my family is ............ 10.The income, if any of other members of my family residing with me is as under, (details shall be furnished) :- 11.The nature of legal aid or advice required is and the same is in respect of....... (State the nature of disputes, claims or right and the document right and other relevant particulars thereof.) 12.The proof in support of my aforesaid claim / right / defence / plea is as under,(state in details):......................... 13.I have / have not applied for legal aid or advice previously. (If applied previously, state the details thereabout including the result and if any advice was given, state the advice.) .............................................................................................. 14.I am willing to furnish such further information and particulars as may be required for the purpose of enabling the................ Authority / Committee to consider this application fully. 15.I am / am not in a position to bear the expenses of- the Court case and the costs of miscellaneous proceedings. (The Applicant may also state the amount, which he is prepared to pay by way of costs and miscellaneous costs or a portion or part thereof.) 16.I shall reimburse the............... Authority / Committee all costs, charges and expenses incurred by the said ........... Authority / Committee in giving me legal aid, if the Court passes a decree or order in my favour awarding costs, or other monetary benefit or advantage to me or if I cease to be entitled to get the legal aid under these regulations. 17.The above statements are true to the best of my knowledge and belief. Date.Signature or thumb impression of the Applicant PlaceAddress................
