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Name / Company Name *

Tel: *

Email: *

Address *

Postcode: *

DOB

Length of Service

Effective Date of Termination

Type of Dispute

Grievance Raised/Outcome of Grievance

ACAS Early Conciliation

Case at Tribunal /Court?

Case No/Claim No:

Date of instructions:

NI Number

Other Party Name:

Other Party Address and Telephone:

Their Ref:

Other Party Company House Number:

Other Party Date of incorporation:

What is the Issue?

Next

Name

What is their case:

Any agreement?

Their Solicitor’s Detail?

Phone

Submit