1
Request that the costs of transcripts be paid at public expense
Part 52 Civil Procedure Rules; Paragraph 5.17 of the Practice Direction applies.
This form should be fully completed and returned to the court
together with a copy of your appeal notice.
Wherever possible you should provide documentary proof of the information you provide. Failure to do so
may delay your application.
Have you obtained any
estimate of the costs of
providing a transcript from the
transcribers?
If Yes, please provide a copy
of the estimate
About the case
Case/Claim number or
Appeal number
Date of order you are
appealing/intend to appeal
and name of judge who made
the order
What part of the proceedings
do you want to be
transcribed?
If you have ticked Evidence
or Entire proceedings, please
give reasons for your request.
Date Name of judge
Yes No
Copy enclosed
EX105 Request that the cost of transcripts be paid at public expense (01.07) © Crown copyright 2007
Judgment only
Evidence only
Entire proceedings
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2
Have you made a previous
application for transcripts to
be paid at public expense on
this or any other matter?
If Yes, please provide details
including court references
About you
Last name/family name
Please use BLOCK LETTERS
First name
Please use BLOCK LETTERS
Address
Please include the postcode
Contact telephone number
Relationship status
Others
State who they are and why
you look after them nancially
Mr Mrs Miss Ms
Other
Single
Married/Civil Partnership
Other
Dependants
The people who you look
after nancially
Give the number of children aged:
Under 11 yrs 16 to 17
11 to 15 18
Yes No
Previous applications
3
About your nances
If employed, please state
your occupation
Employed Unemployed Retired
If you are employed, give
name and address of your
employer*
*You should also supply a copy
of your last three wage slips and
your P60
Employment status
Property in which
you live
In your own property In rented property In lodgings
In property that you own
jointly with someone else
Other
(please explain below)
Do you or your spouse/
partner have an interest in
any other property?
If Yes, please provide details
Yes No
Bank account (Current) Premium Bonds
Bank account
(Deposit)
Stocks or shares
(or both)
Building Society
Account (1)
National Savings
Investments
(2)
Other saving (Give details)
Your savings
Give total amount for each
type of savings you and your
partner have.
If you do not have one of the
types of savings shown, put
‘NIL’.
4
Your usual take-home
pay
a month
Child Benet
a month
Your partner’s usual
take-home pay
a month Other benet or income which is
Income from other
people who live with you
a month a month
Pension(s) a month
(1) State
a month a month
(2) Private or
Occupational
a month a month
Total income
each month
Your usual income
Give the amount you receive
each month for each type of
income.
If you do not have one of the
types of income shown, put
‘NIL’.
Add up the amounts and put
the sum in the ‘Total income
each month’ box.
Rent or Mortgage
a month
Child care
a month
Council Tax
a month
Travelling expenses
a month
Food and household
essentials
a month
Water and Sewerage
charges
a month
Maintenance and
Child Support
a month
Court nes
a month
Electricity
a month
Outstanding debts
a month
Gas, coal or oil
a month
Clothing
a month
Telephone
a month Other expenses which are
TV rent and licence
a month a month
a month
a month
Total expenses
each month
a month
Your usual expenses
Give the amount you pay
each month for each type of
expense.
If you do not have one of the
types of expense shown, put
‘NIL’.
Add up the amounts and
put the sum in the ‘Total
expenses each month’ box.
5
If Yes, give name and
address of creditor and
approximate amount
outstanding
Do you have any debts?
Yes No
Date
Declaration
I declare that the information I have given is true to the best of my knowledge and belief and I understand that:
I will be asked to provide documents as evidence to support my statements;
my application will not proceed if I do not provide the evidence;
my application will be refused if I have not disclosed any relevant facts in this form.
Signature Name
(please print)
Date
For Court use only
Application granted as requested
Application granted in these terms:
Transcript of evidence only
Transcript of judgment only
Application refused
Signed
Judge
Name Address Amount
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