Full Name (Required):
Contact Number:
Email Address (Required):
Name of Employer (Required):
Job Title:
Start Date (Required):
End Date (if applicable):
Reason given for dismissal: 50
Did you appeal the decision: YesNoN/A
Provide a brief summary of your version of events if you disagree with the reason provided: 650
What type of claim do you believe you have? (E.g. unfair dismissal, discrimination, unlawful deduction of wages, breach of contract etc.) If you are not sure please state that:
Why do you believe this claim applies to your situation? 650
If discrimination, please confirm your protected characteristic(s) (i.e. age, belief/religion, marriage/civil partnership, race, sexuality, sex, pregnancy/maternity, disability, gender reassignment):
If discrimination, please briefly explain why you believe you were treated less favourably due to your protected characteristic: 650
What evidence do you have to support your claim? 350
Have you raised a grievance internally? YesNo
Have you started ACAS early conciliation? YesNo
Have you found a new job? YesNo
Our approach is to balance the need to protect your interests with keeping the wider picture in perspective
Call us now: 01543 420 000
