Legal Clients datasheet

Confidential Legal Client datasheet
I am a *

Solicitor Self-represented party A 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 Name Last Name
Name of Law firm
Mobile Number
Work Number
Home Number
E-mail
Skype ID
Residential address

Street Address

Street Address Line 2

State

Post code Country
Is your postal address the same with your residential address

YES NO
Postal Address

Street Address

Street Address Line 2

State

Post code Country
Description of matter
Matter type

Mediation - Family Mediation - Commercial Legal - Commercial Legal - Criminal Legal - Body Corporate
Are you legally represented?

Yes No
Scope of engagement

Opinion General consultation Body Corporate development Negotiation Mediation BCCM (Conciliation/ Adjudication) Application Tribunal application (Example QCAT) Interim matters Interlocutory proceedings Bail application Sentence Trial - Criminal Trial - Commercial Appeal Other (Please specify)
Please specify the scope of engagement
Time frame for the matter
Further Description of matter
Identification Details
ID Type

Drivers License Other
Please Specify other ID type
Emergency contact details
Name

First Name Last Name
Relationship
Phone Number
E-mail
Address

Street Address

Street Address Line 2

State

Post code Country
Upload documentation (If applicable)
Upload Document(s)

Upload a File
Add more files if required Cancel of
Should be Empty:

Confidential Legal Client datasheet