Legal Aid Application

Date *

Branch *

Membership Number * Last 6 Digits only

Name

Home Email *

Address *

Telephone Number *

Date of birth * Enter date on DD/MM/YYYY format, or use the picker to choose your date of birth. You can click the month and year to choose your date of birth.

Employer *

Job Title *

Salary *

Start date with employer *

Last date of service with employer (if applicable)

Please tick one *

Employment advice
Police/NHS fraud investigation
Self inflicted death

Please give an explanation of the legal advice required *

Please attach any documents, notes, emails, pay slips etc relevant to your case

Undertaking *

I have read the guidance notes relating to my claim and the Legal Advice Handbook which outlines the Rules of the Legal Aid Scheme.
If the Legal Aid Committee agrees to refer my case to the Union’s Solicitors, I undertake not to discuss or settle my case without reference to them. I agree to abide by such Regulations as the POA from time to time introduces in relation to the conduct of legal work on behalf of members of the POA.

Consent * For more information about how we use your data, take a look at our Privacy Policy.

I consent to the POA using my data for the purposes of this claim.

Legal Aid Application

Please complete the form below