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Panel Lawyer Application
Law Firm Information
Principal Contact First Name:		* (* Denote required fields )
Principal Contact Last Name:		*
Principal Contact Middle Name:
Principal Contact Email:		*
Date admitted to the Bar:	/ / (MM/DD/YYYY)*	Province: *
Full Firm Name:	*
Mailing Address Street:	* Suite:
Mailing Address City:	*
Mailing Address Province:	*	Postal Code: *
Telephone Number:	*	Fax Number:
Total number of lawyers in your firm:
List any additional office locations:
Additional Address Street:	Suite:
Additional Address City:
Additional Address Province:		Postal Code:
Telephone Number:		Fax Number:

Please complete the details of each lawyer who will provide services under this Agreement
Lawyer name: Admitted to Bar: (mm/dd/yyyy) Current Hourly Fee: $ /hr
Lawyer name: Admitted to Bar: (mm/dd/yyyy) Current Hourly Fee: $ /hr
Lawyer name: Admitted to Bar: (mm/dd/yyyy) Current Hourly Fee: $ /hr
Lawyer name: Admitted to Bar: (mm/dd/yyyy) Current Hourly Fee: $ /hr

Are you or any of your staff fluent in any foreign languages? (please list)


List any disciplinary actions or complaints filed against your law firm with any disciplinary authority, the dates filed, and the outcome of the complaints:
*

Other than Commercial Law, what other areas of law does your law firm handle and identify those in which you specialize:
Specialize
Specialize
Specialize
Specialize
Specialize

Please indicate the cities within a 80 km radius of your office (click here to see list of cities):

By checking the box below and submitting this on-line form you acknowledge the following: I hereby make application for my firm to join the Lawyer Panel in the legal services plans of STERLON. I represent and warrant that: (a) all of this firm’s lawyers who will render services to STERLON legal plan members are duly qualified to practice law before the courts of the province shown on this application and we maintain an office for the private practice of law within that province; (b) our firm maintains legal malpractice insurance coverage of at least $250,000; (c) I have received and read a copy of the Panel Lawyer Agreement and agree that if this application is accepted, this firm will, while a Panel Lawyer, be bound by all the terms, conditions and subsequent amendments thereof. I understand that this Panel Lawyer Agreement may be terminated at any time by either this firm or STERLON and that notice of termination must be in writing and shall become effective upon receipt by the other party.
I have reviewed the Terms of Agreement and would like to be considered as a panel lawyer