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Application (temporary basis)
admin
2020-03-22T09:31:05+00:00
1. Rules
Yes
I confirm that I have read and understood the Rules relating to my application which can be located on the CLSB website.
2. Purpose of Declaration
Yes
(a) I make these declarations for first provision of services on a temporary or occasional basis in England and Wales (please complete all sections); or
Yes
(b) I make these declarations for renewal of a declaration.
In the event of (b): If no material change in your right to practice or documents submitted with your first declaration has occurred please continue to complete sections 3,4,8,13,14,15,16, and 19. If material changes have occurred since first declaration please indicate on the form the nature of the changes and provide the relevant documents in support.
3. Freedom to Provide Services on a Temporary or Occasional Basis
I am applying to provide services on a temporary or occasional basis as follows:
Duration
Frequency
4. Applicant Details
Full name
Date of birth
Gender
---
male
female
Place of birth
Postal address
Passport number/identity card number
Email address
Telephone number
Home State:
Postal address
Telephone number
Email address
5. Nationality
I ATTACH proof of my nationality
6. Profession
I pursue the following profession(s) in my Home State:
Profession (title and description)
Date practising from
7. Legal Establishment
Please state:
Yes
(a) My profession set out under section 6 above
is regulated
in my Home State, or
Yes
(b) My profession as set out under section 6 above
is not regulated
in my Home State. In the event of (b)
Yes
I
have
acquired professional experience of that profession for at least one year during the last ten years in my Home State.
Yes
I
have not
acquired professional experience of that profession for at least one year during the last ten years in my Home State.
(Please provide more information)
8. Practising Jurisdictions
I ATTACH an Attestation from my Home State certifying that I am legally established in that state for the purpose of pursuing the activities concerned and that I am not prohibited from practising, even temporarily, at the time of delivering the Attestation.
9. Professional Qualifications
I ATTACH copies of my professional qualifications as set out below.
Qualification
Awarding body
Date achieved
Duration of education & training
10. Practising Certificates
I ATTACH copies of my current practising certificates as set out below.
Registration/licence number
Practising certificate
Issuing body
Dated
Note:
Where your Home State does not require a practising certificate please provide details on a separate sheet of Costs Lawyer work undertaken by you over the last 10 years and ATTACH supporting evidence (minimum one year required).
11. Professional Body Membership
I am a member of the following professional bodies:
Professional body (Please include address)
Date of full membership
Membership no
12. Regulated Activities
I am authorised and regulated to undertake the following activities under my practising certificate(s) in my Home State:
Regulated activity (reserved legal activity)
Regulator
I confirm I am currently authorised under my current practising certificate(s) in my Home State to undertake the following regulated activity (reserved legal activity):
Regulated activity (reserved legal activity)
The exercise of a right of audience
Yes
No
The administration of oaths
Yes
No
The conduct of litigation
Yes
No
13. Disclosure: Offences
Yes
(a) I
have never
been subject to any conviction, caution, reprimand, warning, fine including spent convictions. (other than for a minor motoring offence)
Yes
(b) I
have
been subject to a conviction, caution, reprimand, warning, fine including spent convictions. (other than for a minor motoring offence)
(In the event of (b) please provide more information)
14. Disclosure: Others
Yes
(a) I
have never:
Been declared an un-discharged/discharged bankrupt.
Entered into an individual voluntary liquidation arrangement.
Entered into a partnership voluntary insolvency arrangement.
Been a director of a company or a member of an LLP which has been wound up or the subject of an administration order, administrative receivership or voluntary insolvency arrangement.
Been disqualified from being a company director.
Been removed from the office of charity trustee or trustee for a charity.
Been identified as lacking capacity under mental health legislation.
Been the subject of a money judgement outstanding for more than 28 days.
Yes
(b)
I have:
Been declared an un-discharged/discharged bankrupt.
Entered into an individual voluntary liquidation arrangement.
Entered into a partnership voluntary insolvency arrangement.
Been a director of a company or a member of an LLP which has been wound up or the subject of an administration order, administrative receivership or voluntary insolvency arrangement.
Been disqualified from being a company director.
Been removed from the office of charity trustee or trustee for a charity.
Been identified as lacking capacity under mental health legislation.
Been the subject of a money judgement outstanding for more than 28 days.
(In the event of (b) please provide more information)
15. Practising Offences
Yes
(a) I
have never
been:
Struck off.
Subject to conditions on my right to practice.
Suspended from practising professionally.
Yes
(b) I
have
been:
Struck off.
Subject to conditions on my right to practice.
Suspended from practising professionally.
(In the event of (b) please provide more information)
16. Disciplinary Issues
Yes
(a) I
have never
been subject to any disciplinary proceedings.
Yes
(b) I
have
been subject to disciplinary proceedings.
(In the event of (b) please provide more information)
17. Disclosure and Barring Service (DBS) Checks
I ATTACH the result of my enhanced level DBS check (or equivalent in my Home State with an independent translation into English).
(In the event the check does not come through evidencing a clean record, please explain)
18. English Language
Yes
(a) English is my first language.
Yes
(b) English is my second language.
In the event of (b) I declare that my fluency in English is such that I can practice the profession of Costs Lawyer to the standard expected by the CLSB, and that I agree to an interview with a representative of the CLSB in order to establish this to their satisfaction, if they request this.
19. Insurance
I ATTACH evidence of my current professional indemnity insurance. I understand that in the event my application is successful I will be required to evidence to the CLSB that I have put in place professional indemnity insurance (minimum £100,000 and includes loss of documents cover) for working in England & Wales unless I work exclusively in-house for a firm of Costs Lawyers/Solicitors/other organisation as an employee (PAYE) basis.
20. References
I understand the CLSB reserves the right to take up references on considering my application.
Personal Referee (Name, address & phone number)
How do you know this referee?
Professional Referee (Name, address & phone number)
How do you know this referee?
Declaration of Truth by Applicant
In submitting this application I understand that any non-disclosure or incorrect statement herein will be treated by CLSB as an act of dishonesty.
Enclosure Checklist
Yes
Proof of nationality
Yes
Attestation form Home State certifying establishment
Yes
Professional qualifications
Yes
Practising certificates
Yes
Evidence of work (See note under 10)
Yes
DBS check (Home State) with independent translation into English
Yes
Professional indemnity insurance
CLSB Checks
Please note CLSB may contact professional bodies for verification of authenticity of qualifications and membership which may delay your application.
Queries
The CLSB can be contacted by:
Email :
[email protected]
Phone : 0161 956 8969
Post : CLSB, Centurion House, 129 Deansgate, Manchester, M3 3WR
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