Fillable Certicate of Loss of Earnings (Cabinet Office)

Fill Online, Printable, Fillable, Blank Certicate of Loss of Earnings (Cabinet Office) Form

Use Fill to complete blank online CABINET OFFICE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Certicate of Loss of Earnings (Cabinet Office)

On average this form takes 6 minutes to complete

The Certicate of Loss of Earnings (Cabinet Office) form is 2 pages long and contains:

  • 0 signatures
  • 0 check-boxes
  • 22 other fields

Country of origin: UK
File type: PDF

Use our library of forms to quickly fill and sign your Cabinet Office forms online.

BROWSE CABINET OFFICE FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Certicate of Loss of Earnings
for self-employed or company directors
Name of Crown Court Juror’s no.
If you are not required to attend court on a particular day will
you be able to return to work?
For a full day
Yes No
For a half day
Yes No
Declaration
I certify that I normally earn £
(gross) per day and that I have lost/will lose that amount each day.
I certify that the information supplied is correct and I understand that I may be prosecuted if I have given any
information, which I know to be false or do not believe to be true.
Signed
Print your name Date
Certicate of Loss of Earnings - self-employed or company director (08.17)
You should use this form if you are self-employed or a company director and need to claim for earnings you
lose while serving as a juror.
You cannot claim for a loss of earnings for work at the weekend or a bank holiday, as you will not be serving as a juror
when the courthouse is closed, and so will not incur a nancial loss during those days.
You must supply documents as evidence of the amount you would have earned while you served as a juror and
evidence that you are registered as self-employed or a salaried company director with HMRC. See overleaf for a
checklist to advise what documents the Court requires to consider your claim. The Court cannot pay any charges from
your accountant to provide any information. The Jury Ocer/Manager will be able to advise you if your documents
and evidence are acceptable to prove your claim.
Each claim will be assessed on a case-by-case basis. If you have any questions about claiming for nancial loss in
your circumstances, please speak to a member of sta. They can advise you what you are entitled to claim and what
evidence you need to provide to make your claim.
Your name
Your profession
On what date will you return to work?
Which days and hours do you usually work?
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Hours worked COURT CLOSED
For jurors who are company directors
Please ensure you have enclosed the following documentation with your
certicate of loss of earnings.
Most recent tax return including calculation used to arrive at the
loss of earnings gure you are claiming from the Court
or
Accountants letter conrming your average daily gross income
along with HMRC evidence (showing your UTR number) you are
registered as a salaried paid company director
If you are unable to provide any of the above evidence please speak to
the Jury Ocer/Manager who can advise you further.
For jurors who are self-employed
Please ensure you have enclosed the following documentation with your
certicate of loss of earnings.
Most recent tax return including calculation used to arrive at the
loss of earnings gure you are claiming from the Court
or
Accountants letter conrming your average daily gross income
along with HMRC evidence (showing your UTR number) you are
registered as self employed
or
Ocial letter from a company that would have provided you work
which you have been unable to accept due to jury service conrming
what your daily pay would have been along with HMRC evidence
(showing your UTR number) you are registered as self employed
If you are newly self-employed and unable to provide any of the above
evidence please speak to the Jury Ocer/Manager who can advise you
further.
Certicate of loss of earnings checklist
Reset form
Print form
Reset form
Print form
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Certicate of Loss of Earnings (Cabinet Office)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 15 February 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document