Regulations Regarding the Sample Form of the Application Regarding the Request of State Ensured Legal Aid and Income by a Foreigner to be Removed

Issued pursuant to
Section 50.² , Paragraph two of the Immigration Law

1. This Regulation prescribes the sample form (Annex) of the submission of a foreigner to be removed for request for State ensured legal aid and income.

2. The text of the sample form of the submission of a foreigner to be removed for request for State ensured legal aid and income alongside with the Latvian language may also be available in English, French, Russian or Spanish.

3. This Regulation shall come into force on 23 December 2011.

Prime Minister V. Dombrovskis

Minister for Justice,
Acting for the Minister for the Interior A. Štokenbergs

Annex
Cabinet Regulation No. 733
27 September 2011

Application
Regarding the Request of State Ensured Legal Aid and Income by a Foreigner to be Removed

(Complete the form in block letters)

1. Personal data

Person who wishes to receive State ensured legal aid:

Given name, surname
Date of birth	.   .     .
	dd/mm/yyyy

Gender:	male				female
Nationality
Personal identity number or identification number (if any) granted by the State
Contact details
		(telephone number, e-mail, fax)
Address of the place of residence
Language spoken

Mark, if you are:

a foreigner, who resides in the Republic of Latvia and regarding whom a decision has been taken on the contested voluntary return decision

a foreigner, who resides in the Republic of Latvia and regarding whom a decision has been taken on the contested removal order

Personal identification document:

Date of the issuance	.   .     .
	dd/mm/yyyy

Document number (series)
Issued by
	(state, institution)
The term of validity of the document			.   .     .
			dd/mm/yyyy

Representative of the person who wishes to receive State ensured legal aid:

(if the person exercises his/her rights through a representative)

Given name, surname
Date of birth	.   .     .
	dd/mm/yyyy

Gender:	male			female
Personal identity number or identification number (if any) granted by the State
Contact details
		(telephone number, e-mail, fax)
Location
Language spoken

Mark, if you are:

	legal representative (guardian, trustee)
	authorised person
	other
Representation grounds

Information on income and property status:

2. Information on the issue, which requires State ensured legal aid:

Circumstances that shall be taken into account:

The decision to grant State ensured legal aid or to refuse to grant State ensured legal aid (mark the appropriate):

	send by post
		(specify the address)
	send electronically
			(specify the e-mail address*)
	other means for communicating the decision

The following documents have been attached to the application:

Copies of the documents have been submitted	Originals of the documents have been submitted
		1.
		2.
		3.
		4.

I hereby declare that the provided information is true and complete, and undertake to notify the Legal Aid Administration regarding any changes in the information abovementioned in an application immediately, but no later than within a period of seven days after learning thereof.

I agree that the Legal Aid Administration will carry out processing of personal data required for the execution of the tasks related to the provision of State ensured legal aid and its improvement, including transferring of the information to the provision of State ensured legal aid, and also to persons who need such information to carry out research in accordance with the requirements of the laws and regulations governing personal data protection.

I am informed that the expenditure related to the provision of State ensured legal aid may be recovered from me in full amount, if the Legal Aid Administration establishes recovery cases set out in the State Ensured Legal Aid Law (for example, false or incomplete information has been provided which served as the basis for receiving State ensured legal aid or State ensured legal aid has been received unduly).

Notes.

1. * The document will be sent using a secure electronic signature.

2. ** The details of the document "date" and "signature" shall not be completed if the electronic document has been prepared in accordance with the laws and regulations regarding the drawing up of electronic documents.

Minister for Justice,
Acting for the Minister for the Interior A. Štokenbergs

Translation © 2016 Valsts valodas centrs (State Language Centre)