Date of Birth
Place of Birth (country)
National Insurance No.
Please provide the details where you are most likely to be contactable:
Have you checked your home insurance policies for legal cover?
Do you have legal expenses cover that may cover a Tribunal claim?
If yes, please provide the name of the insurer
Address of insurer
Name of policy holder
Have you submitted an application from the insurer yet?
If yes, have the insurers said that they will cover the claim?
Name of employer you intend to claim against
Address of employer (give registered address if a limited company)
Address where you worked
Please provide a description of your role
Are you still employed?
If no, what date did your employment end?
Please provide details of any breaks in employment
Were you taken on via an agency?
Have you worked for your employer on a "self employed" basis?
What is your immigration status?
Pay: Gross per annum
Take home pay (Net pay) per month
Please provide details of any bonuses, including amount and how often they were received
Please provide details of any benefits. For example, car, phone, pension, etc.
Number of people employed with you
Your line manager
Have you been subject to any form of discipline at work (eg written or verbal warnings/ suspension)?
Have you lodged any grievances at work?
Have you ever been involved in any previous court or tribunal cases?
Number of hours worked per week
Does your employer pay all of your tax and National Insurance for you?
Are you aware of any failings by your employer to pay tax and National Insurance?
If you are aware of any evidence that your employer might have (or might request) which could damage your case or credibility, you must tell us below. Such evidence may include:
Compromising emails that you may have sent to or from work (whether or not they have been deleted)
Previous problems at work (including other places of employment)
Documents that may damage your case
Any claim, which your employer might have against you - eg negligence or any other monetary claim.
Are you aware of any such evidence?
If yes, please provide details
Looking for work
Since losing your job, have you been looking for work?
If yes, please provide details of your efforts to find a job, including applications, adverts, job centre records and diaries.
If no, please explain why (eg medical reasons)
Type of Case
It is important to fully state your case when we lodge your claim as you may be prevented from doing so later.
Please tick any of the following that you would like to discuss
Please describe anything else you would like to discuss
Most cases have to be brought within three months of the matter complained of. If you are too late, please be prepared to explain why. Should the incident you are complaining about be over three months ago, please phone us before your appointment.
Have you lodged a complaint already?
If you have answered yes to the previous question, please fax or email the claim form (IT1) with any defence lodged by your employer in form IT3 to us using out
Please think about how we might prove the key elements of your case. This evidence may be in the form of documents or witnesses. Please provide details below.
Please indicate if you have any of the following documents. Select
You if you have it, Emp if your employer has it, or N if you do not have it or are unsure.
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.
Witness 1: Name
Date of birth
Witness 2: Name
Date of birth
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
If you ticked 'other', please provide a brief description of what you hope to achieve
If there are any medical issues, please provide you GP's details below. Medical reports may be served on your opponent or sent to the Tribunal.
GP's full name
Statement of Case
We need you to say in your own words ˇ°what happenedˇ± that has led to you 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.
If you prefer, you may send us a pre-prepared a statement, in Microsoft Word, WordPad or Notepad formats. (Maximum file size of 512Kb)
Document to send
Document 2 to send
Document 3 to send
Document 4 to send
Document 5 to send
Where did you find us?
To assist us with our Market Research, could you please indicate how you found this site? If you used a search engine, could you let us know which one, and what keyword(s) you used?
How you found us
The key search phrase or word used
You now need to click 'Send Information', below, which will send your information to an employment law solicitor. Thank you for taking the time to complete this questionnaire. It will help us deal with your enquiry more speedily.