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ANNEXURE O 4
APPLICATION FOR ACCREDITATION BY LEGAL PRACTITIONER
A. PARTICULARS OF APPLICANT
NAME SURNAME
ID NO. GENDER MALE FEMALE
DISTRICT WHERE MAINLY PRACTISING
PRACTITIONER CELL
PRACTITIONER EMAIL
B. PRACTITIONER DETAILS PRACTITIONER TYPE Advocate Attorney
PROFESSIONAL BODY
RIGHT OF APPEARANCE IN HIGH COURT Y/N CSD REGISTRATION NO
LANGUAGES other than English
C. AREAS WILLING TO UNDERTAKE WORK ( list additional courts in annexure )
COURT COURT
Y/N Y/N
Y/N Y/N
D. SUPPORTING DOCUMENTATION
Attorney- HC Work Copy of ID CSD Report
E1 CRIMINAL WORK EXPERIENCE 0-1years 1-2years 3-5years 5-10years 10 years +
(select relevant experience per court type )
1. DISTRICT COURT
2. REGIONAL COURT
3. HIGH COURT
< 1 year 1-2 years 3-5 years 5-10 years 10 years +
E2 CIVIL WORK EXPERIENCE (Level 1) (Level 2) (Level 3) (Level 4) (Level 5)
Litigation in Magistrate Court Family law work Litigation in High Court
Alternative dispute resolution/arbitration/commercial or nonlitigious work Labour Law matters
TICK IF YOU ARE A SPECIALIST IN ANY OF THE FOLLOWING:
Restitution of Land Rights Act, 1994 Labour Court / Labour Appeal Court matters Refugees Act, 1998
Land Reform (Labour Tenants) Act, 1996 Prevention of Illegal Evictions From and Occupation of Land Act, 1998
Extension of Security of Tenure Act, 1997 Hague Convention on Aspects of International Child Abduction Act, 1996
E3 Are you willing to do Pro-Bono work for the Legal Aid SA Clients? Y/N
I certify that the details stated above are true and correct and undertake to immediately inform Legal Aid SA of changes.
F. SIGNATURE AND DATE I also declare that I am not a government employee or an employee of a Legal Aid SA Co-operation Partner.
DATE:
SIGNATURE OF APPLICANT: D D / MM M / 2 0
J2
ANNEXURE O 4
VENDOR DETAILS OF LEGAL FIRM OR ADVOCATE
G. PARTICULARS OF APPLICANT FIRM / ADVOCATE’S PRACTICE
NAME OF FIRM
TYPE OF LEGAL ENTITY PARTNERSHIP SOLE PRACTITIONER INCORPORATED COMPANY
MAIN PRACTICE POSTAL ADDRESS
C O D E
Vendor Telephone Number:
Vendor Fax:
Vendor Email:
Docex No: VAT Registration No:
H. BROAD BASED BLACK ECONOMIC EMPOWERMENT CREDENTIALS (B-BBEE)
OWNERSHIP DETAILS.
No. African No. Indian No. Coloured No. White
EMPLOYMENT EQUITY. applying for accreditation
No. African No. Indian No. Coloured No. White
TOTAL PRACTITIONERS. including those not applying for accreditation
Total number of practitioners in employ of Vendor
I. ELECTRONIC FUNDS TRANSFER DETAILS
BANK
BRANCH NAME
BRANCH CODE
ACCOUNT NUMBER
ACCOUNT TYPE CHEQUE SAVINGS TRANSMISSION (Mark account type)
J. SIGNATURE AND DATE
I/We hereby instruct and authorise the Legal Aid SA to pay amounts which may accrue to me/us to the credit of the above mentioned bank account or any other bank
or branch to which I/we may transfer my/our account. I/We understand that the credit transfers hereby authorised will be processed through a computerised system
provided by the South African banks and I/we also understand that details of each payment will be printed on my/our bank statement or an accompanying voucher.
(This does not apply where it is not customary for banks to furnish bank statements, e.g. Savings or transmission accounts).
ASSIGNMENT/CESSION
I/We may not cede or assign this instruction nor any of my/our rights or obligations arising out of the execution thereof. Should I/We do so, then Legal Aid SA is not
SIGNED AT on this day of 20
SIGNATURE I UNDERTAKE TO IMMEDIATELY INFORM THE LEGAL AID SA OF ALL CHANGES TO THE ABOVE DETAILS
