UNIVERSITY OF MAKATI

SCHOOL OF LAW
LEGAL AID CLINIC

CLIENT INFORMATION AND INTAKE FORM

Control No: _____________
Date/ Petsa: _____________
Client’s Profile
(Impormasyon ng Kliyente)

____________________________________________________________________________
(Last Name) (First Name) (Middle Name)
(Apelyido) (Pangalan) (Gitnang Pangalan)

Are you known by any other name? [ ] YES [ ] NO

(Kilala ka ba sa ibang pangalan) (Oo) (Hindi)

If yes, the name/s are: ___________________________________________________________

(Kung Oo, sa anong pangalan) (Nickname, Maiden Name)
(Palayaw/ Pangalan ng Pagkadalaga)

Address: ______________________________________________________________________
(Tirahan) (House No.) (Street) (Barangay)
(Numero ng Bahay) (Kalye)

_____________________________________________________________________________
(City) (Zip Code)
(Siyudad)
Date of Birth: __________________________ Place of Birth: _______________________
(Petsa ng Kapanganakan) (Lugar ng Kapanganakan)

CONTACT INFORMATION
(Impormasyong Pang-komunikasyon)

Telephone No.: ____________________ Email Address: _______________________

Cellphone No.: ____________________

Preferred address for correspondence:

(Lugar kung saan ibig makatanggap ng mga sulat o impormasyon:)
_____________________________________________________________________________
_____________________________________________________________________________

Civil Status: [ ] SINGLE [ ] MARRIED [ ] WIDOWED [ ] OTHERS, specify: _________

(Katayuang (Binata/ (Kasal) (Balo) (Iba pa, tukuyin:)
Sibil) Dalaga)

Name of Spouse: _______________________________________________________________

(Pangalan ng Asawa)
Occupation:____ _______________________________________________________________
(Trabaho)
Name of children, if any:
(Pangalan ng mga anak, kung meron:)
_____________________________________________________________________________
_____________________________________________________________________________
EMPLOYMENT PROFILE
(Impormasyon Tungkol Sa Trabaho)

Occupation: __________________________________________________________________
(Trabaho)
Name of Employer: ____________________________________________________________
(Pangalan ng Pinagtratrabahuhan)
Address of Employer: __________________________________________________________
(Lugar ng Pinagtratrabahuhan)
Monthly Family Income: ________________________________________________________
(Buwanang Kiita)

*if self-employed, specify name and nature of business:

(kung self-employed, pakitukoy kung anong pangalan at uri ng pinagkakakitaang ito:)
_____________________________________________________________________________

Nature of legal assistance requested:

(Uri ng legal na tulong)

[ ] Legal Representation (Representasyong Legal)

[ ] Legal Advice (Payong Legal)
[ ] Others, specify: (Iba pa, tukuyin:)_______________________________________________

Engagement Terms: [ ] Paying [ ] Legal Aid

(Kasunduan) (Magbabayad) (Libreng Serbisyong Legal)

Is it your first time seeking legal advice on this matter? [ ] YES [ ] NO

(Ito ba ang unang pagkakataon na humanap ka ng legal na payo?) (Oo) (Hindi)
 CASE INFORMATION
(Impormasyon ng Kaso)

Nature of the case

(Uri ng Kaso)
[ ] CIVIL [ ] CRIMINAL [ ] ADMINISTRATIVE [ ] LABOR
(Sibil) (Kriminal) (Administratibo) (Trabaho)
[ ] OTHERS, specify: ___________
(IBA PA, tukuyin:)

Brief statement of client’s situation / circumstances

(Buod ng pahayag ng kliyente sa kanyang sitwasyon/ kalagayan)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

I hereby affix my signature to attest to the truth of the foregoing facts.

(Nilagdaan ko po ito bilang pagpatunay na ang lahat na nakasaad sa itaas ay pawang katotohan.)

_________________________________
Signature of Client
(Lagda ng Kliyente)

PRIVACY NOTICE

All information provided will be kept confidential. We will not disclose your personal information
to a third party without your consent, unless we are required or authorized to do so by law or other
regulation. (Ang lahat ng impormasyong inyong ibinigay ay pananatilihin naming kumpidensyal. Hindi namin
ibubunyag sa iba ang inyong personal na impormasyon na wala ang inyong pahintulot, maliban na lamang kung
kinakailangan ayon sa batas at ng iba pang regulasyon)
 TO BE ACCOMPLISHED BY ASSISTING LAWYER

Documents presented:
(Mga dokumentong ipinakita)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Action to be taken:
(Aksyong gagawin)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

____________________________________
Assisting Lawyer
(Abogado)

TO BE ACCOMPLISHED BY ASSISTING LAWYER

Documents required:
(Kinakailangang mga dokumento)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Important dates/ deadlines:

(Mga importanteng petsa/ deadlines)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Follow-up conferences/ meetings:

(Mga susunod na pagpupulong/ pagkikita)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

____________________________________
Assisting Lawyer
(Abogado)