Legal Clients datasheet

Confidential Legal Client datasheet
I am a*

SolicitorSelf-represented partyA party to a mediation
The preliminary information below is provided by you on a strictly confidential basis. The response to queries will form a basis upon which a retainer will be drafted and provided to you, and assists in gaining an initial understanding of your matter and its urgency.

Should there be any matters that you require clarification on, please contact us here.
Name of matter
Your File Ref no
The preliminary information below is provided by you on a strictly confidential basis. The response to queries will form a basis upon which an agreement to mediate will be drafted and provided to you, and assists in gaining an initial understanding of your matter and its urgency.

Should there be any matters that you require clarification on, please contact us here.
Contact Information
Name

First NameLast Name
Name of Law firm
Mobile Number
Work Number
Home Number
E-mail
Skype ID
Residential address

Street Address

Street Address Line 2

CityState

Post codeCountry
Is your postal address the same with your residential address

YESNO
Postal Address

Street Address

Street Address Line 2

CityState

Post codeCountry
Description of matter
Matter type

Mediation - FamilyMediation - CommercialLegal - CommercialLegal - CriminalLegal - Body Corporate
Are you legally represented?

YesNo
Scope of engagement

OpinionGeneral consultationBody Corporate developmentNegotiationMediationBCCM (Conciliation/ Adjudication) ApplicationTribunal application (Example QCAT)Interim mattersInterlocutory proceedingsBail applicationSentenceTrial - CriminalTrial - CommercialAppealOther (Please specify)
Please specify the scope of engagement
Time frame for the matter
Further Description of matter
Identification Details
ID Type

Drivers LicenseOther
Please Specify other ID type
Emergency contact details
Name

First NameLast Name
Relationship
Phone Number
E-mail
Address

Street Address

Street Address Line 2

CityState

Post codeCountry
Upload documentation (If applicable)
Upload Document(s)

Upload a File
Add more files if required Cancelof
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Confidential Legal Client datasheet