DELHI HIGH COURT LEGAL SERVICES COMMITTEE

33-38, Lawyers Chamber, Delhi High Court, New Delhi

Tel. No. 23383418, 43010101 Extn. 4381
Email : hclsthebest@yahoo.co.in

________________________________________________________________________________________________

APPLICATION FORM
Application No._______________ (to be allotted by DHCLSC)
(To be filled by the candidate)

Paste latest passport

size photograph &
sign the same in
such a manner that
part of signature
appears on the form
and part on the
photograph.

Application for empanelment of :

(Please in one column as an applicant can apply for only one panel).
Criminal Panel
Civil Panel
Jail Visiting Panel
Mediator Panel
1.

Applicants Name
(In Block Letters)

: _____________________________________________

2.

Fathers / Husbands Name :

____________________________________________

3.

Date of Birth

4.

Age (as on 1st February, 2016) :

____________________________________________

5.

Residence Address

: ____________________________________________

: ____________________________________________
____________________________________________

6.

Office/ Chamber Address

____________________________________________
____________________________________________
____________________________________________
Telephone No. (R)

: ____________________________________________

Telephone No. (O)

: ____________________________________________

Mobile No.

: ____________________________________________

e-mail

: ____________________________________________

7.
Enrolment No. : ___________________
Date of
________________
(Attach self attested copy of enrolment certificate).

Enrolment

8.
Actual practice experience (Duration of actual practice in the
Courts): _____________
(Attach
an
experience
certificate
issued
by
the
Bar
Association/Council)

9.

Specify the Jail where the candidate intends to visit, if necessary :

(Please the column)
Tihar Jail
Rohini Jail
Not interested in Jail Visits

10.

Specify experience in :
High Court of Delhi/ Supreme Court of India _____________

District Courts
_________________
11.

Labour

Courts

MACT/

any

other

Fora

Specify whether ever remained on the panel of the Delhi High Court
Legal
Services

Services Committee or Delhi State Legal

Authority,

if

yes,

give

details

_____________________________________________________________________________
_
_____________________________________________________________________________
_
12.

Whether any disciplinary case/complaint is pending against the

applicant with any
Bar Council/Authority or any criminal case is pending or has ever
resigned / removed from the panel of DHCLSC/ DSLSA. If yes, give
details : ________________________________
_____________________________________________________________________________
_
_____________________________________________________________________________
_

13. List of the documents to be attached

Self attested copy of Degree of Law.

Self attested copy of Certificate of Enrolment.
Self attested copy of Experience Certificate.
In case applying for Civil & Criminal Panel, any one copy of
Judgment/ order in which applicant argued before High Court of
Delhi.
In case applying for Mediator Panel, copy of 40 hours mediation
training certificate.

DECLARATION

I hereby declare that all the statements made in this application are
true, complete and correct to the best of my knowledge and belief. In
the event of any information being found false /incorrect at any
stage, my candidature shall be liable to be rejected. I have read and
understood the instructions and terms and conditions of the
empanelment and agree to abide by them. I declare that I fulfill the
eligibility conditions for the category to which I am seeking
empanelment.

am

submitting

only

one

application

for

empanelment.

Place: ________________
Date: ________________
(Signature of the Applicant)