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 oce 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 representative’s rm
Claimant’s or claimant’s legal representative’s
address to which documents or payments
should be sent if dierent 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