Employment Tribunal Claim Assessment

Complete the Employment Tribunal Claim Assessment form to see if you qualify. If your claim proceeds it will be on a No Win No Fee basis.

DATA PROTECTION - We take the Privacy and Protection of your Data seriously

All data sent via this form will be handled in compliance with the Data Protection Act 1998 and will be secured over HTTPS Encryption.

If you would prefer to contact us in the first instance please refer to our quick contact form here to alternatively arrange a telephone call.

Please take the time to complete this questionnaire as accurately as possible. To effectively represent you, we will need as much relevant information as you can provide from the very start. This questionnaire will form the basis of your case. If we do not have full details of your case now, it may not be possible to make a claim for all of your losses at a later stage.

Please provide all monetary values in pounds sterling (£)
Name*
Title First Last
Date of Birth
Nationality
Please provide the details where you are most likely to be contactable:
Address*
Street Address Address Line 2 City ZIP / Postal Code
Phone (Work)
Phone (Home)
Phone (Mobile)
Email*

Have you checked your home insurance policies for legal expenses cover?
- Yes
- No
Do you have legal expenses cover that may cover a Tribunal claim?
- Yes
- No
Please provide the name of the insurer
Address of insurer
Street Address Address Line 2 City ZIP / Postal Code
Policy Number
Name of policy holder
Title First Last
Have you submitted an application from the insurer yet?
- Yes
- No
Have the insurers said that they will cover the claim?
Note: You can nominate a solicitor of your choosing to act for you
- Yes
- No

Since losing your job, have you been looking for work?
- Yes
- No
Please provide details of your efforts to find a job, including applications, adverts, job centre records and diaries
Please explain why eg medical reasons

If you know of any witnesses, please provide their full name, date of birth, phone number, address and a note of what they might say. Existing employees might require a witness order.
Name
First Last
Date of Birth
Occupation
Address
Street Address Address Line 2 City ZIP / Postal Code
Evidence

We need to know, from the outset, what you hope to achieve. Please let us know which of the following you hope to achieve.
Tick the appropriate box(es) for what you hope to achieve
- A reference
- Financial compensation
- Your job back
- Relocation
- Other
Please provide a brief description

We need you to say in your own words 'what happened' that has led you to contacting us seeking assistance. It would be useful if this could be in chronological order setting out all relevant dates and what happened on those dates.
This statement needs to set out the nature of your grievance and claim. We are only interested in the FACTS as they happened - leave the legal issues to us.

Please upload your pre-prepared statement in either Microsoft Word or Adobe Acrobat PDF format.
Your Statement & Relevant Documents
Drop files here or

Max. file size: 256 MB, Max. files: 5.

You now need to click 'Send Information' which will send your information to a specialist employment law solicitor.

Thank you for taking the time to complete this questionnaire. It will help us deal with your enquiry more speedily.
Consent*
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I agree to my information being processed by a nominated solicitor for assessment purposes.
Email
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