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Ellis Tate

Intake

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Gender

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Date

Time

Nationality

Marital Status

Single
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Occupation

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Identification

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Different Mailing address

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Mailing Address

Matter Signature Preferred

City/Parish

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Emergency Contact Information

Full Name

Relationship to Client

Phone Number

Address

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IV. Legal Representation Information

Nature of Matter (Brief Description)

Type of Matter

Civil Litigation
Criminal Defense
Family Law (e.g., Divorce, Custody)
Estate Planning/Probate
Corporate/Commercial
Real Estate/Property
Employment/Labour
Immigration
Other

Opposing Party/Entity (if applicable):

Opposing Party’s Attorney (if known):

Any Relevant Deadlines

Preferred Outcome

Urgency

Low
Medium
High

Client’s Income Bracket

Below J$1,000,000
J$1,000,000 – J$5,000,000
Above J$5,000,000

Conflicts OF Interest

Previous Relationship with Opposing Party/Entity

Yes
No

Any Known Conflicts

Client Communication Preferences

Email
Phone
Text Message
In Person Meetings
WhatsApp

Preferred Time of Contact

Morning (9 AM – 12 PM)
Afternoon (12 PM – 5 PM)
Evening (After 5 PM)

CLIENT CONSENT

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I consent to the firm storing my data for the purpose of legal representation.
I have read and agree to the terms outlined in the Engagement Letter provided by the firm.

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