| 1. Applicants Details |
| Name: |
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| Company: |
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| Address: |
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| Telephone: |
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2. Proposed Action
Give a brief description of the claim proposed including the name of the proposed defendant, plaintiff/s, which Court is proposed to pursue the action, an estimate of the likely quantum, type of claim,
possible defences that may be raised by the defendant. |
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| 3. Solicitors Involved |
| Are there any solicitors involved? |
Yes
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| If yes, please provide details: |
| Name of Solicitor: |
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| Address of Solicitor: |
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| Telephone: |
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| Fax: |
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| Email: |
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| Unpaid Fees: |
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4. Time Limit
Is there any known time limit on the commencement of the action and if so what. |
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| 5. Documents |
Please advise what documents are in your possession that can assist us in assessing the merits of the proposed action eg documents which are relevant to quantum, liability, causation, witness statements, court documents if any etc. |
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6. Type of funding sought
Please indicate the type of funding which is sought: |
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| 7. Other Information |
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