DIFC Courts
Ground Level, Building 4
The Gate District
P.O. Box 211724, Dubai, UAE
T: +9714 427 3333
http://www.difccourts.ae
Pro Bono Litigant
Intake Form
For court use only
Ref. No
Please ensure that every section is fully completed. Leave no sections blank. If any section
does not apply, please write ‘N/A’
Pro Bono Applicant (Please indicate whether you will be the claimant or respondent)
Name:
Address:
Telephone:
Fax:
Mobile:
Email:
Opposing Party (Circle One: Respondent/ Claimant)
Name:
Address:
Telephone:
Fax:
Mobile:
Email:
The Courts at the Dubai International Financial Centre, The Gate District, Dubai, UAE, are open between 10am and 5pm,
Sunday to Thursday.
Opposing Counsel (If known)
Name:
Address:
Telephone:
Fax:
Mobile:
Email:
Brief Summary of Claim:
Please provide a summary of the case facts and issues.
The Courts at the Dubai International Financial Centre, The Gate District, Dubai, UAE, are open between 10am and 5pm,
Sunday to Thursday.
Financial Information
1. Savings, investments and other major assets
Provide details of savings, investments, and other major assets (including money in deposit accounts,
shares owned, cars and other significant material assets).
Type of saving, investment or asset
Value (AED)
2. Debts
Provide details of any debt which the applicant has which is still outstanding, including the amount owed.
Creditor
Sum still owed (AED)
Monthly repayment, if any
(AED)
3. Property
Please list each property owned below and continue on a separate sheet if necessary.
Address of property
Approximate current
market value (AED)
Mortgage outstanding (AED)
4. Income (monthly) Please put ‘0’ in any box where there is no income from that source
Salary (gross)
Dhs
Benefits
Dhs
The Courts at the Dubai International Financial Centre, The Gate District, Dubai, UAE, are open between 10am and 5pm,
Sunday to Thursday.
Dhs
Rental income
Partner’s salary
Dhs
Other (please specify):
Pension
Dhs
Income from savings/
investments
Dhs
Maintenance
Dhs
Total Monthly Gross
Income :
Dhs
Bonuses
Dhs
Income (cont.)
Dhs
Dhs
Dhs
5. Expenditure (monthly) Please put ‘0’ in any box where there is no expenditure on that item
Rent
Dhs
Credit cards / hire
purchase
Dhs
Mortgage
Dhs
Leisure
Dhs
Household bills
Dhs
Other
Dhs
Food / clothing
Dhs
Dhs
Transport
Dhs
Dhs
Loan repayments
Dhs
Dhs
Total Monthly
Dhs
Expenditure:
Number of Dependents (please specify):
6. Further information/ Type of Assistance Requested
Please set out below what type of assistance is requested and any further information as to why you feel
unable to pay for legal assistance (if applicable):
The Courts at the Dubai International Financial Centre, The Gate District, Dubai, UAE, are open between 10am and 5pm,
Sunday to Thursday.
Statement of Truth
I believe that the facts stated in this intake form are true, the particulars attached to this form (if any) are
true, and my current financial situation does not permit me to afford a lawyer. If at any time my current
financial situation changes, I will inform the Programme Leader.
I accept and agree that none of the DIFC Courts, the Registrar, the Deputy Registrar, the Pro Bono
Programme Leader and/or any other servant of the DIFC Courts shall be liable to any party howsoever
for any act or omission in connection with any pro bono matter, save where the act or omission is shown
by the party to constitute conscious and deliberate wrongdoing committed by the body or person alleged
to be liable.
Signature:
Date:
Name (Printed):
The Courts at the Dubai International Financial Centre, The Gate District, Dubai, UAE, are open between 10am and 5pm,
Sunday to Thursday.