N1 Claim form (CPR Part 7) (06.16) © Crown Copyright 2016
Claim Form
Brief details of claim
name and
address for
service including
Claimant(s) name(s) and address(es) including postcode
Defendant(s) name and address(es) including postcode
You must indicate your preferred County Court Hearing Centre for hearings here (see notes for guidance)
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.
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.
Amount claimed
Court fee
Legal representatives costs
Total amount
In the
Fee Account no.
Help with Fees -
Ref no. (if applicable)
For court use only
Claim no.
Issue date
Statement of Truth
*(I believe)(The Claimant believes) that the facts stated in these particulars of claim are true.
* I am duly authorised by the claimant to sign this statement
signed position or oce held
*(Claimant)(Litigation friend)
(Claimant’s legal representative)
*delete as appropriate
Claim No.
(if signing on behalf of rm or company)
Particulars of Claim (attached)(to follow)
Full name
Name of claimant’s legal representatives rm
Claimant’s or claimant’s legal representative’s
address to which documents or payments
should be sent if dierent from overleaf including
(if appropriate) details of DX, fax or e-mail.
Does, or will, your claim include any issues under the Human Rights Act 1998? Yes No
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