Yes No Yes No Published on National Portal of India (india.gov.in) Government of Orissa Law Department SUPREME COURT LEGAL SERVICES COMMITTEE Application for Legal Services The Secretary, Supreme Court Legal Services Committee, Supreme Court Compound, New Delhi-110 001. 1. Name: (In Block Letters) 2. Father's Name Husband's Name: 3. Address: (a) Residential: (b) Occupational: Age and Date of Birth: 4. (a) (b) Education: Status: 5. 6. Number of dependants & their relation to the Applicant 7. Any other financial liabilities: /- (Attach Income Certificate from a Revenue Officer) Rs. 8. Income per Month: 9. Occupation: Other sources of Income, if any: 10. Yes No Yes No Sources and monthly income of Member of the family: Details and value of moveable& immovable assets held by the applicant, his dependent and other members of his family 12. 13. Any other relevant information: 14. Nature of Legal Service and Advice sought: Whether belong to 15. Schedule Castes Schedules Tribes Child Women (Please attach Certificate): Whether the matter in the respect of which legal services and advice is now sought was filed previously in the Supreme Court/ if so the result : 16. 17. Whether opinion of any advocate has been sought in the matter/ if so the particulars of the Advocate and his opinion Verified that the information given above is true and correct. Signature Dated: Name: Place: Address: Published on National Portal of India (india.gov.in) 11. Delete 0 Delete 0 Delete 0 (c) I am eligible for legal services as I am a woman/ Child. Published on National Portal of India (india.gov.in) VAKALATNAM A IN THE SUPRME COURT OF INDIA Criminal / Civil / Special Leave Petition / Appeal / W.P. No of 20 Appellant(s) Petitioner(s) Versus Respondent(s) I/We the Appellant(s) /Petitioner(s)/ Respondent(s) in the above Suit/Appeal /Petition/Reference do hereby(s) appoint and retain Supreme Court, on behalf of the SUPREME COURT LEGAL SERVICES COMMITTEE to act and appear for me/us in the above Suit/Appeal/Petition/Reference and on my/ our behalf to conduct and prosecute(of defined) the same and all proceedings that may be taken in respect of any application connected with the same or any decree or order passed there in including proceedings in taxation and Application for REVIEW to file and obtain of return on documents and to deposit and receive money on my/our behalf in the said Suit/ Appeal / Petition/ Reference and in Application for Revenue and to represent me /us and to take all necessary steps on my/our behalf in the above matter. I /We agree to rectify all acts done by the aforesaid Advocate in purchase of this Authority Dated this the Appellant(s) /Petitioner(s)/Respondents/Caveator. ACCEPTED Advocate on behalf on the Supreme Court Legal Services committee, 100, Lawyer's Chambers, Post Office Wing, Supreme Court Compound, New Delhi-110 001 . AFFIDAVIT I, Aged about years Resident of son daughter wife of Sri do here by solemnly affirm and state as under: 1. (a) I belong to a member of a scheduled Castes Scheduled Tribes. (b) I am a victim of trafficking in human being of a beggar. Delete 0 Delete 0 Delete 0 Delete 0 Delete 0 Delete 0 Delete 0 20 Verified on this day at ( HH:MM ) DEPONENT Published on National Portal of India (india.gov.in) (d ) I am mentally ill or otherwise disable person. I am a person under circumstances of underserved want being a victim of a mass disaster, ethnic violence caste atrocity, flood, drought,earthquake or industrial disaster. (e) (f) I am an industrial workmen. (g) I am in custody. My annual income from all sources is below Rs.50,000/- ( Rupees Fifty thousand) (h) (Delete whatever is not applicable) I shall comply with any requisition and direction that may be made by the Secretary or any of the members of the Supreme Court Legal Services Committee. 2. I shall furnish full and true information of all facts of my case to the legal Services advocate to be provided by the Committee. 3. In appeal from the Judgment of in (a) (b) In writ Jurisdiction for (Delete whatever is not applicable) I hereby agree that in the event of the Court passing a decree order in my favour awarding cost to me or other monetary benefit or advantage, I shall repay by way ofreimbursement to the committee all costs, charges and expenses incurred by the committee in giving me legal services. I hereby also authorize the Secretary of the Supreme Court Legal Services Committee to do all such acts and things as may be necessary for recovery or realization of the amount decreed or ordered to be paid to me and do reimburse the same for the above mentioned purpose 4. I agree that my case be listed before Lok Adalat in Hon'ble Supreme Court, if any stage it is considered by the committee that my matter can be reconsidered or settled through Lok Adalat 5. DEPONENT Verification: the above-named Shri/Smt./Kum I Deponent do hereby verify that the contents of the paragraphs 1 to 5 are true and correct to my knowledge nothing stated therein false and nothing has been canceled. Son Note: The affidavit must be on non-judicial stamp paper of appropriate value under theStamp Act of your State and sworn before on Oath Commissioner or Notary Public or 1st Class Magistrate. IN THE SUPREME COURT OF INDIA (Appellate Appellate/Original jurisdiction S.L.P. / Appeal/W.P./ T.P./Civil/ Cr of 20 Petitioner(s) Versus Respondent(s) AFFIDAVIT OF FACTS I Daughter of Age year,by profession Resident of do solemnly affirm and stand state as follows: 1. I am the pairokar/one of the petitioners/appellants/respondent in the above matter and such acquainted with the facts if the case. 2. The facts stated in the accompanying petition are true to my knowledge and the rest are on information derived from the papers of the case and believed to be true. 3. That no Special Leave /W.P/ T.P./ has been filed on the above matter earlier by me in the Hon'ble Supreme Court against the impugned order/ Judgment. Decree for similar relief. 4. The facts stated in the accompanying Misc. petition (namely Stay / Condonation of delay / Bail application) for filling proof of surrender / exemption from filing of the impugned order/ application for substitution of L.R.S. and others Misc. Petition with their annexures are true and correct to my knowledge derived from the record of the case and my personal knowledge. and to 5. I say that the facts stated in paragraphs pages to of the Special Leave Petition and pages to of the list of dates are true to my personal knowledge and the submissions made therein are based on legal advice which I received and believe to be true. 6. That the annexures being enclosed with the petition, are true copies of there respective originals DEPONENT Published on National Portal of India (india.gov.in) VERIFICATION: I, Deponent above named, do so solemnly affirm and declare that the contents of the fore-going affidavit are true to my knowledge and no part of it is false and nothing material has been concealed. this the day of Verified DEPONENT Published on National Portal of India (india.gov.in)
