FORM I KERALA STATE LEGAL SERVICES AUTHORITY (Regulation 40) FORM OF APPLICATION TO BE MADE FOR LEGAL SERVICES To .......................................................Authority/Committee ........................................................ ........................................................ 1. Name in Full : 2. Age and Sex : 3. Father's/Husband's Name : 4. Occupation : 5. Address : 6. Caste : 7. Annual Income : 8. Whether eligible for : legal aid, if so how 9. Name of Court or : Authority and nature of Proceedings 10. Particulars of the legal : services sought for 11. Whether an affidavit : regarding income is enclosed 12. Any other particulars : which the aplicant desires to furnish Place: Signature/Thumb impression Date: of the applicant DECLARATION I,....................................................., the applicant hereby solemnly affirm and declare that what is stated above is true to the best of my information, knowledge and belief. Signature/Thumb impression of the applicant
