Does, or will, your claim include any issues under the Human Rights Act 1998? Yes No
Particulars of Claim (attached)(t
Statement of Truth
e)(The Claimant believ
es) that the facts stated in these particulars of claim are true.
* I am duly authorised by the claimant to sign this statement
*delete as appropriate
Name of claimant’s legal representative’s rm
(Claimant’s legal representative)
position or oce held
(if signing on behalf of rm or company)
Claimant’s or claimant’s legal representative’s
address to which documents or paymen
should be sent if dierent from overleaf including
(if appropriate) details of DX, fax or e-mail.