Legal Aid Declaration Your First Name*Your Middle NameYour Surname*Your Email* Your Case Number (FMM/*****)*Your Mediator*I don't knowSara RobinsonJane SmithJuliette DalrympleLesley DudlestonRachel RenwickLorraine MacNayDate of your meeting with us* Date Format: MM slash DD slash YYYY Please Confirm: * I have read and checked the Legal Aid Means 7 form completed by Family Matters Mediate Limited at my Mediation Information and Assessment Meeting (MIAM) * As far as I know, all the information I have given is true and I have not withheld any relevant information. I understand that if I knowingly give false information or withhold relevant information it could affect my entitlement to Legal Aid * I understand that I must tell you immediately if there are any changes in my or my partner's financial circumstances * I agree to the Legal Aid Agency checking these facts with others such as the DWP and HM Revenue and Customs and I authorise those people / organisations to provide the information they ask for Signed:*Date: 08/09/2024Date* Date Format: DD slash MM slash YYYY CAPTCHA