A few more details please...

First Name*

Last Name*

Email*

Phone (Mobile in most cases)*

Details of claim

What type of case do you have?*

Are You Still Employed?*

No
Yes

What was your length of service with the company?*

What is your length of service with the company?*

What is the general nature of the enquiry?*

Were you dismissed or did you resign?*

Reason your employer gave for your dismissal?*

PLEASE NOTE: Redundancy is also considered a dismissal under employment law.

Brief Details of Dismissal*

Please concisely set out why you were dismissed and why you believe your dismissal was unfair.
For instance, I was dismissed for alleged theft, but the I deny that I stole anything and the CCTV footage is inconclusive.

Did the company carry out a disciplinary process?*

Yes
No

Did the company carry out a redundancy consultation?*

Yes
No

Brief details of Resignation*

Please concisely list the reason(s) for your resignation and in particular give details of the 'final straw' which made you resign.

Did you raise a grievance prior to resignation?

Yes
No

Please give brief details of why you chose not to raise a grievance?*

Does your case fall into any of the following categories?*

You have limited rights with less than two years service. Does your case fall into one of the categories listed?

Type of discrimination*

There are only nine protected characteristics. Anything outside of these categories will not count as discrimination under the Equality Act 2010.

Have you suffered harassment or victimisation?

Harassment is when someone behaves in a way which offends you or makes you feel distressed, degraded, humiliated or intimidated (eg sex or racial harassment).
Victimisation is when an employer treats you badly because you have made a claim or a complaint about discrimination, ie retaliation for speaking out about discrimination in the work place.

What is your disability?

The definition of a Disability under the Equality Act 2010 is a physical or mental impairment that has a substantial and long term negative effect on your ability to do normal daily activities.

Please state disability here

For example: Long term depression, MS, Cancer, Blindness, Bipolar etc.

Please describe how you were treated unfavourably because of your disability, including details failure to make reasonable adjustments.

Broadly speaking, discrimination arises when you are treated unfavourably because of a protected characteristic. Please give concise details of the treatment you received, including dates.

Describe BRIEF details of the protected disclosure/whistleblowing?

About and to whom did you make the protected disclosure/blew the whistle.
e.g. I work in a care home. On 25 March 2018, I emailed my line manager about a resident being neglected.

Please describe brief details of the defamatory comment.

Please include (1) the date(s) of the defamatory comment/s (2) who they were made to and (3) please obtain information as to ability of the opponent to pay damages and costs.

Please describe brief details (additional - Client input)*

What is your key date?*

A key date is the date of the "thing" that you wish to make a claim about.
For instance, date of dismissal, resignation, TUPE transfer, act of discrimination/victimisation or date of unlawful deduction from wages

Please describe brief details (non-employment)?*

Thanks for the information that you have provided so far, but in order to assess the case more efficiently, please provide us with a few more details about your case.

Please also include details of key dates.

Value of claim

Are there any other aspects to your claim (please choose one)?*

If there are more aspects to your claim, Please include details "Additional Information" at the end of the form.

Are you owed wages, holiday pay, bonus, commission etc?

Yes
No

How much are you owed?(£) Leave blank if unknown.

Legal Costs

If we are unable to place your case on a no-win-no-fee basis, are you willing to contribute to legal costs?*

We will make every attempt to place your case with a no-win-no-fee solicitor, however if your case is unsuitable for no-win-no-fee, are you able to contribute legal costs?

Yes
No
Maybe

Do you have legal expenses insurance?*

Yes
No
Maybe

Have you been offered a settlement agreement?*

Yes
No

ACAS/Tribunal Information

Have you submitted to ACAS yet?*

Yes
No

Have you received your ACAS Certificate yet?*

Yes
No

What is the date on the certificate?*

Have you submitted an ET1 to the Tribunal yet?*

Yes
No

Financial Information

What do you get paid? (£)*

Is this per week, month or year*

Week
Month
Year

Is this before or after tax?*

Before
After

Additional Information

Consent

Your GDPR Consent*

By ticking this box, you consent that you are happy for your personal details and case information to be passed to and used by Tom Street & Co. panel Lawyers/Barristers to assess and accept your potential claim. You also agree that you can be contacted by Tom Street & Co. and their panel Lawyers/Barristers.

Comments

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