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BATCH 95

BAR COUNCIL LEGAL AID CENTRE (KUALA LUMPUR)


Sign-up sheet for Programs
*** Kindly ensure that your writing is legible to avoid confusion. Alternatively you may TYPE IT OUT.

ORIENTATION DATE: ……………


1 NAME : ………………………..………… GENDER (circle): MALE / FEMALE
IC NO : ………………………………..… TELEPHONE (HP): ……………………………
E-MAIL: ……………………............... FAX : ….......................................

PUPILS MASTER NAME : …………………………………………………………………..

FIRM NAME : ……………………………………………………………………

ADDRESS : ……………………………………………………………………

………………………………………………………………………

2 EMERGENCY CONTACT:[NAME]……………………………..[Phone No]: ..............................

3 MEDICAL CONDITION : ……………………………………………………………………


*You are required to inform the BCLAC Secretariat if you have any medical illness

4 LANGUAGES/DIALECTS SPOKEN :1…………….…… 2…………………… 3……………..


4………..………… 5…………………… 6……....……...
5 DATE OF COMMENCEMENT OF PUPILAGE : ………………………………………

6 DATE OF “SHORT CALL” : ……………………………………....

7 UNIVERSITY, ACADEMIC & PROFESSIONAL QUALIFICATIONS: ……………………


(e.g. LLB (Lon)/CLP)

8 Describe Legal Aid And Social Service Experience, If Any: ……………………………………

9 AREAS OF PRACTICE : ……………………………………………………………………..


(e.g. civil/criminal litigation, banking/finance, corporate/commercial)

10 PROGRAM SELECTION:
 For the dock brief program you must have locus which is 3 months after your short-call date.

1ST CHOICE : _______________________________________________________


REASON(S) FOR CHOICE:

2ND CHOICE : _______________________________________________________


REASON(S) FOR CHOICE:

SIGNED: ..................................................................................

Legal aid (Batch 95/2018)


NOTE: We will try to assign you to your 1st or 2nd choice program. The assignment will take into account the
information you have provided above. However, it is possible that you may not get either choice.

Legal aid (Batch 95/2018)