Contact us:

    My Name is:

    My Email Address is:

    My Telephone Number is:

    A summary of my enquiry and what I am looking to achieve is:


      Your name:

      Date of birth:

      Your email address:

      Your telephone number:

      What is the name of your employer/former employer?

      Date of commencement of employment:

      Date of termination of employment (unless continuing):


      Gross £

      per (month,week, etc)

      Net £

      per (month,week, etc)

      Benefits (please list)

      Do you consider that you have been discriminated against by reason of your sex, race, age or disability or other reason

      What is your characteristic which you
      consider has given rise to this discrimination?
      [e.g. sex – female, race – black African, age – in my 60s,
      disability – multiple sclerosis etc.]

      Describe in full what you consider to have constituted discrimination?

      Are you owed any money by your employer?
      [If so answer questions below]

      What are you owed the money for
      [e.g. wages, commission, expenses etc.]

      How much are you owed?

      Describe here any additional complaints
      you have against your employer

      Have you submitted a grievance to your employer?

      Have you commenced any tribunal action in relation to the above?

      If so, on what date did you file your claim?

      Do you have legal expenses insurance as part of your
      insurance policy that you have (e.g. home buildings or contents policies).