N1 Claim form (CPR Part 7) (06.16) © Crown Copyright 2016
Claim Form
You may be able to issue your claim online which may
save time and money. Go to www.moneyclaim.gov.uk
to nd out more.
In the
Fee Account no.
Help with Fees -
Ref no. (if applicable)
H W F
For court use only
Claim no.
Issue date
Claimant(s) name(s) and address(es) including postcode
SEAL
Defendant(s) name and address(es) including postcode
Brief details of claim
Value
You must indicate your preferred County Court Hearing Centre for hearings here (see notes for guidance)
Defendant’s
name and
address for
service including
postcode
£
Amount claimed
Court fee
Legal representatives costs
Total amount
For further details of the courts www.gov.uk/nd-court-tribunal.
When corresponding with the Court, please address forms or letters to the Manager and always quote the claim number.
Claim No.
Does, or will, your claim include any issues under the Human Rights Act 1998? Yes No
Particulars of Claim (attached)(t
o follow)
Statement of Truth
*(I believ
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
Full name
Name of claimant’s legal representatives rm
signed
*(Claimant)(Litigation friend)
(Claimant’s legal representative)
position or oce held
(if signing on behalf of rm or company)
Claimant’s or claimant’s legal representative’s
address to which documents or paymen
ts
should be sent if dierent from overleaf including
(if appropriate) details of DX, fax or e-mail.
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