Yes
I confirm that I have read and understood the Rules relating to my application which can be located on the CLSB website.
(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
(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.
I am applying to provide services on a temporary or occasional basis as follows:
Duration
Frequency
Full name
Date of birth
Gender—Please choose an option—malefemale
Place of birth
Postal address
Passport number/identity card number
Email address
Telephone number
Home State:
I ATTACH proof of my nationality
I pursue the following profession(s) in my Home State:
Profession (title and description)
Date practising from
Please state:
(a) My profession set out under section 6 above is regulated in my Home State, or
(b) My profession as set out under section 6 above is not regulated in my Home State. In the event of (b)
I have acquired professional experience of that profession for at least one year during the last ten years in my Home State.
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)
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.
I ATTACH copies of my professional qualifications as set out below.
Qualification
Awarding body
Date achieved
Duration of education & training
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).
I am a member of the following professional bodies:
Professional body (Please include address)
Date of full membership
Membership no
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):
The exercise of a right of audience YesNo
The administration of oaths YesNo
The conduct of litigation YesNo
(a) I have never been subject to any conviction, caution, reprimand, warning, fine including spent convictions. (other than for a minor motoring offence)
(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)
(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.
(b) I have:
(a) I have never been:
Struck off.
Subject to conditions on my right to practice.
Suspended from practising professionally.
(b) I have been:
(a) I have never been subject to any disciplinary proceedings.
(b) I have been subject to disciplinary proceedings.
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)
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.
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.
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)
In submitting this application I understand that any non-disclosure or incorrect statement herein will be treated by CLSB as an act of dishonesty.
YesProof of nationality
YesAttestation form Home State certifying establishment
YesProfessional qualifications
YesPractising certificates
YesEvidence of work (See note under 10)
YesDBS check (Home State) with independent translation into English
YesProfessional indemnity insurance
Please note CLSB may contact professional bodies for verification of authenticity of qualifications and membership which may delay your application.
The CLSB can be contacted by:
Email : [email protected]
Phone : 0161 956 8969
Post : CLSB, Centurion House, 129 Deansgate, Manchester, M3 3WR
