Legal Aid Declaration - Family Matters Mediation

Your First Name*
Your Middle Name
Your Surname*
Your Email*
Your Case Number (FMM/*****)*
This can be found in the subject line of any emails you have received from Family Matters.
Your Mediator*
Date 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: 15/01/2025
Date*
Date Format: DD slash MM slash YYYY
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