Form 12.A-A

Rule 12A.1(4)

Application by party litigant for lay support

PART 1:  to be completed by the party litigant

Cause Ref:

Name and designation of pursuer:

Name and destination of defender(s):

Name and address of proposed named individual who is to support you:

Is the named individual related to you?  If so, please state the relationship.

Does the named individual have relevant experience (e.g. acted as authorised lay representative in the sheriff court, acted as a McKenzie Friend in England and Wales, legal qualification, experience as a lay adviser on legal matters)?  If so, please briefly describe that experience.

						(Signed)

						[Name of applicant]
[Date]

PART 2:  to be completed by the prospective named individual

I confirm the information above

I declare that:

(a)  I have no financial interest in the outcome of the case or I have the following financial interest in it.*

(b)  I am not receiving remuneration from the litigant, directly or indirectly, for my assistance and will not receive any such remuneration;

(c)  I accept that documents and information are provided to me by the litigant on a confidential basis and undertake to keep them confidential.

*delete as appropriate			(Signed)
		
						[Name]
						[Date]