QUANTUM LITIGATION FUNDING

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Please complete as much of the application as possible and we will then contact you to arrange a confidential discussion. All information will be treated with the utmost confidence. If you require any assistance in completing this application please contact us on (03) 9607 8317.

This communication (including the documents attached) and all future communications in connection with this proposal are confidential, made at a time when litigation is either in existence or contemplated, provided for the sole purpose of litigation and provided without any intention to waive legal professional privilege.

APPLICANT DETAILS

Name: *

Please enter your full name

Company:

Please enter your company name

Address:

Please enter your address

Email: *

Phone:

Please enter your phone number or mobile number

Fax:

Please enter your fax number

THE CLAIM

Who is it against: *

Have proceedings commenced:

Yes

No

Court in which proceedings have been / will be issued?:

Amount of Claim:

Description of claim: *

Does anyone have any security over any settlement proceeds?:

Yes

No

If yes, please provide details:

DETAILS OF LEGAL ADVISORS

Are there any solicitors and/or barristers currently involved?:

Yes

No

Name of solicitor:

Solicitors Firm:

Solicitors phone:

Solicitors fax:

Solicitors email:

Solicitors address:

Amount if any of unpaid fees to Solicitor:

Name of barrister:

Barristers Firm:

Barristers phone:

Barristers fax:

Barristers email:

Barristers address:

Amount if any of unpaid fees to Barrister:

DOCUMENTS INCLUDED

Please include all documents relevant to the assessment of the cause of action and its quantum, including:

All pleadings
Any documents relating to the calculation of damages
All written legal advice received
Material source documents
A chronology

Document 1:

Document 2:

Document 3:

Document 4:

Document 5:

OTHER LITIGATION FUNDING APPLICATIONS

Have you applied or do you intend to apply to other litigation funders in respect of this claim:

Yes

No

If yes, please provide details:

Have you been refused funding by a litigation funder in respect of this claim:

Yes

No

DISCLOSURE

I hereby confirm that all the information contained in this Application is correct to the best of my knowledge and belief. I am not aware of any material ommissions.

I agree that the folling information is correct: *

Yes

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1. Standard Application Form
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