Pro bono centrum Pro bono aliance

PRO BONO CENTRUM

Request for the provision of pro bono legal services for the client of non-profit organization

! to fill marked fields are required *

1. Contact information of nonprofit organization

Name of organization: *
Contact person (in relation to the case): *
Telephone (Contact person of the case): *
Mobil phone: *
Email (Contact person of the case): *

2. Basic information about the case

Law area: *

3. Information about client

Name and surname of the client: *
Age: *
Place of residence (municipality): *   
Citizenship: *

4. Description of the case of the client (please do not put personal information of the client)

Please summarize the basic factual circumstances and challenges and provide all important data.

*

 

5. Information about the proceedings

Name and surname / the name of the counter party in the event of litigation:
Contact details counterparties:
Court / administrative authority / other institution where the procedure is conducted:
Address of court / other institutions:
Case number:
        

6. Ordered judicial / administrative negotiations / hearings/ other action

Type of negotiations: judicial / administrative negotiations, hearings / other action Institution: Date: Time: Place:

7. What kind of assistance gives your organization to the client?

What kind of assistance gives your organization to the client?

In case that pro bono serviced will be conveyed, will your organization be able, if it will be necessary, provide the client withthe followingforms of assistance?(Check all that you will be able to provide.)

8. Examine your organization that the client qualifies for inclusion in the intermediation of pro bono legal services?

*

9. Is the client provided by different legal assistance now?

*

10. Was provided legal assistance to the client different in the same case? If so, why was providing legal assistance terminated?

*

If you have any questions, please contact us at telephone: + 420 774 887 792.

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