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home Uitvoeringswet Verdrag inzake de toegang tot de rechter in internationale gevallen en Europese Overeenkomst inzake het doorzenden van verzoeken om rechtsbijstand Artikel 21
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Uitvoeringswet Verdrag inzake de toegang tot de rechter in internationale gevallen en Europese Overeenkomst inzake het doorzenden van verzoeken om rechtsbijstand

 
Artikel 21
Deze wet treedt in werking op een bij koninklijk besluit te bepalen tijdstip.
Lasten en bevelen dat deze in het Staatsblad zal worden geplaatst en dat alle ministeries, autoriteiten, colleges en ambtenaren wie zulks aangaat, aan de nauwkeurige uitvoering de hand zullen houden.
Gegeven te ?s-Gravenhage, 28 oktober 1991
Beatrix
De Minister van Justitie,
e
M. H. Hirsch Ballin
De Staatssecretaris van Justitie,
a
Kosto
Uitgegeven de vierentwintigste december 1991
De Minister van Justitie,
e
M. H. Hirsch Ballin
Application for legal aid Convention on International Access to Justice, signed at The Hague, the 25th of October 1980.
European Agreement on the transmission of applications for legal aid
1
Name and address of the applicant for legal aid
2
Court of tribunal in which the proceedings have been or will be initiated (if known)
3
a). Subject-matter(s) of proceedings; amount of the claim, if applicable
b). If applicable, list of supporting documents pertinent to commenced or intended proceedings) Delete if inappropriate.)
c). Name and address of the opposing party) Delete if inappropriate.)
4
Any date or time-limit relating to proceedings with legal consequences for the applicant, calling for speedy handling of the application) Delete if inappropriate.)
5
Any other relevant information) Delete if inappropriate.)
6
Done at ..., the ...
7
Applicant?s signature
Statement concerning the applicant?s financial circumstances
i
Personal situation
8
name (maiden name, if applicable)
9
first name(s)
10
date and place of birth
11
nationality
12
a). habitual residence (date of commencement of the residence)
b). former habitual residence (date of commencement and termination of the residence)
13
civil status (single, married, widow(er), divorced, separated)
14
name and first name(s) of the spouse
15
names, first names and dates of birth of children dependent on the applicant
16
other persons dependent on the applicant
17
supplementary information concerning the family situation
ii
Financial circumstances
18
occupation
19
name and address of employer or place of exercise of occupation
20
income
of the applicant
of the spouse
of the persons depeudent on the applicant
a)
salary (including payments in kind)
b)
pensions, disability pensions, alimonies, allowances, annuities
c)
unemployment benefits
d)
income from non-salaried occupations
e)
income from securities and floating capital
f)
income from real property
g)
other sources of income
21
real property
of the applicant
of the spouse
of the persous dependent on the applicant
(please state value(s) and obligations)
22
other assets
of the applicant
of the spouse
of the persons dependent on the applicant
(securities, sharings in profits, claims, bank accounts, business capital, etc.)
23
debets and other financial
of the obligations
of the applicant
of the spouse persons dependent on the applicant
a)
loans (state nature, balance to be paid and annual/monthly repayments)
b)
maintenance obligations (state monthly payments)
c)
house rent (iucluding costs of heating, electricity, gas and water)
d)
other recurring obligations
24
income tax and social security contributions for the previous year
25
remarks of the applicant
26
if applicable, list of supporting documents
27
The undersigned, being fully aware of the penalties provided by law for the making of a false statement, declares that the above statement is complete and correct.
28
Done at ... (place)
29
the ... (date)
30
.. (applicant?s signature)


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