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Application for Continued Premium Exempt Status for Pro Bono Services on behalf of Non-profit Organizations

Any lawyer member of the Law Society of Ontario (LSO) exempt from payment of Professional Liability Insurance premiums who performs pro bono services on behalf of a non-profit organization(s), and who wishes to remain exempt, must apply for a continuation of the lawyer member's eligibility for exemption using this form.

In completing this form, I confirm that:

1. I am currently exempt from the payment of Professional Liability insurance premiums under the LSO insurance program.

2. I will perform pro bono professional services on behalf of a non-profit organization(s), and apply for a continuation of my eligibility for an exemption from payment of Professional Liability insurance premiums.

NON-PROFIT ORGANIZATION INFORMATION


Name of non-profit organization:

Address of non-profit organization:

Contact Person at non-profit organization:

Telephone:

The activity of the non-profit organization is (ie its purpose, services provided etc)

I have made inquires and confirm that this organization is a non-profit organization.

Yes     No

Is this non-profit organization a registered project with Pro Bono Ontario?

Yes     No

Is this non-profit organization a clinic (within the meaning of the Legal Aid Services Act, 1998), a student legal aid services society, or an Aboriginal legal services corporation, that is funded by Legal Aid Ontario?

Yes     No



The pro bono professional services I will perform are:

The timeframe for the performance of these pro bono services is:

Lawyer Name:
LSO#:

Please check this box to evidence your signature.

Please type the code shown in the image:


  

 

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