Einde inhoudsopgave
Uitvoeringswet Verdrag inzake de toegang tot de rechter in internationale gevallen en Europese Overeenkomst inzake het doorzenden van verzoeken om rechtsbijstand
Application for legal aid
Geldend
Geldend vanaf 01-06-1992
- Bronpublicatie:
28-10-1991, Stb. 1991, 679 (uitgifte: 24-12-1991, kamerstukken: Staten-Generaal Digitaal: 21497 Overheid.nl: 21497)
- Inwerkingtreding
01-06-1992
- Bronpublicatie inwerkingtreding:
28-02-1992, Stb. 1992, 155 (uitgifte: 01-01-1992, kamerstukken/regelingnummer: -)
- Vakgebied(en)
EU-recht / Bijzondere onderwerpen
Burgerlijk procesrecht / Algemeen
Convention on International Access to Justice, signed at The Hague, the 25th of October 1980.
- 1.
Name and address of the applicant for legal aid
- 2.
Court of tribunal in which the proceedings have been or will be initiated (if known)
- 3
- a)
Subject-matter(s) of proceedings; amount of the claim, if applicable
- b)
If applicable, list of supporting documents pertinent to commenced or intended proceedings (*)
- c)
Name and address of the opposing party (*)
- 4.
Any date or time-limit relating to proceedings with legal consequences for the applicant, calling for speedy handling of the application (*)
- 5.
Any other relevant information (*)
- 6.
Done at …, the …
- 7.
Applicant's signature
Statement concerning the applicant's financial circumstances
I. Personal situation
- 8.
name (maiden name, if applicable)
- 9.
first name(s)
- 10.
date and place of birth
- 11.
nationality
- 12
- a)
habitual residence (date of commencement of the residence)
- b)
former habitual residence (date of commencement and termination of the residence)
- 13.
civil status (single, married, widow(er), divorced, separated)
- 14.
name and first name(s) of the spouse
- 15.
names, first names and dates of birth of children dependent on the applicant
- 16.
other persons dependent on the applicant
- 17.
supplementary information concerning the family situation
II. Financial circumstances
- 18.
occupation
- 19.
name and address of employer or place of exercise of occupation
20
income
of the applicant
of the spouse
of the persons dependent on the applicant
a)
salary (including payments in kind)
b)
pensions, disability pensions, alimonies, allowances, annuities
c)
unemployment benefits
d)
income from non-salaried occupations
e)
income from securities and floating capital
f)
income from real property
g)
other sources of income
21
real property
of the applicant
of the spouse
of the persons dependent on the applicant
(please state value(s) and obligations)
22
other assets
of the applicant
of the spouse
of the persons dependent on the applicant
(securities, sharings in profits, claims, bank accounts, business capital, etc.)
23
debets and other financial
of the obligations
of the applicant
of the spouse persons dependent on the applicant
a)
loans (state nature, balance to be paid and annual/monthly repayments)
b)
maintenance obligations (state monthly payments)
c)
house rent (including costs of heating, electricity, gas and water)
d)
other recurring obligations
- 24.
income tax and social security contributions for the previous year
- 25.
remarks of the applicant
- 26.
if applicable, list of supporting documents
- 27.
The undersigned, being fully aware of the penalties provided by law for the making of a false statement, declares that the above statement is complete and correct.
- 28.
Done at … (place)
- 29.
the … (date)
- 30.
… (applicant's signature)