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FORMULIR KONSULTASI BANTUAN HUKUM I.
DATA PEMOHON / KLIEN 1. Nama 2. Tempat / Tanggal lahir 3. Jenis Kelamin 4. Kawin / belum kawin / duda / janda 5. Tempat tinggal (Alamat) Kelurahan / Desa Kacamatan Kabupaten / Kota 6. Pendidikan 7. Pekerjaan
: : : : : : : : : :
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II.
Pelaksanaan konsultasi hukum (tanggal/bulan/tahun) . ................................................................................................................................................. .................................................................................................................................................
III.
Uraian Singkat Pokok Masalah san Latar Belakang. ................................................................................................................................................. ................................................................................................................................................. ................................................................................................................................................. .................................................................................................................................................
IV.
Nasihat yang diberikan Konsultan termasuk Aspek Yuridisnya. ................................................................................................................................................. ................................................................................................................................................. ................................................................................................................................................. .................................................................................................................................................
V.
Hasil akhir konsultasi. ................................................................................................................................................. ................................................................................................................................................. ................................................................................................................................................. .................................................................................................................................................
VI.
Kesan konsultas atas tingkat pengetahuan / kesadaran hukum pemohon. ................................................................................................................................................. ................................................................................................................................................. ................................................................................................................................................. .................................................................................................................................................
VII.
VIII.
Pemohon / Klien Nama Tandan Tangan
: :
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Konsultan Hukum Nama Tandan Tangan
: :
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..................,.....................................20... Mengetahui,
(nama OBH) Direktur