Legal Aid NSW CEO's Award 2012 Recognising outstanding service by a private practitioner for a disadvantaged client Application form (Please read Guidelines before completing) Nominee details Indicate whether nominee is an individual lawyer or a firm Individual lawyer Firm Name of nominee Name of firm Firm address Email Telephone/Mobile Fax Nominator details (if not self-nominated) Nominated by Address Telephone/Mobile Fax Case details Client name(s) Legal Aid NSW reference number (if known) Please attach a supporting statement of no more than 500 words. The statement should include a brief description of the service provided and the successful outcome for the client(s). You may submit photographs or other additional items in support (up to a maximum of three). Certification I certify that: The information provided in this application is true and correct I have obtained the necessary permissions regarding client identification and quotes. (Delete 2 if not applicable) Signed: Name: Title: Date:
Legal Aid NSW CEO's Award 2012 Recognising outstanding service by a private practitioner for a disadvantaged client Application form (Please read Guidelines before completing) Nominee details Indicate whether nominee is an individual lawyer or a firm Individual lawyer Firm Name of nominee Name of firm Firm address Email Telephone/Mobile Fax Nominator details (if not self-nominated) Nominated by Address Telephone/Mobile Fax Case details Client name(s) Legal Aid NSW reference number (if known) Please attach a supporting statement of no more than 500 words. The statement should include a brief description of the service provided and the successful outcome for the client(s). You may submit photographs or other additional items in support (up to a maximum of three). Certification I certify that: The information provided in this application is true and correct I have obtained the necessary permissions regarding client identification and quotes. (Delete 2 if not applicable) Signed: Name: Title: Date:
CEOs-Award-2012-Application-form.docx