First Name (required)

Last Name (required)

Your Email (required)

Phone No. (required)

What was your gross salary? (required)

When did your employment start? (required)

When did your employment end? (required)

Or tick here if still employed there:

Have you been dismissed?
YesNo

At the date of dismissal, had you been employed for 2 years?*
YesNo

Have you already commenced tribunal proceedings?
YesNo

Do you have any legal expenses insurance policies that might cover any legal fees?
YesNo

Please tick any box(es) that you are claiming for:
Unfair DismissalConstructive DismissalDiscrimination (e.g. On the grounds of your race, sex, pregnancy, age, sexual orientation etc.)Owed redundancy paymentOwed other paymentsOther (please specify below)

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