Pro Bono Client Financial Eligibility Declaration
Client Information
Name
Date of Birth
Address
Phone
Household Information
Number of people in household (including yourself)
Relationship to client (for each person)
Income Information
Total monthly household income (before taxes)
Sources of income (e.g., employment, benefits, others)
Assets
Estimated total value of household assets (e.g., savings, property, vehicles)
Outstanding Debts/Liabilities
Total outstanding debts/liabilities
Declaration:
I declare that the information provided above is true and correct to the best of my knowledge. I understand that providing false information may disqualify me from receiving pro bono legal services.
Client Signature
Date