Have you been dismissed?

YesNo

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

YesNo

Start date

End date (if dismissed)

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.)Whistle BlowingOwed redundancy paymentOwed other paymentsOther (please specify below)