Claim Form

Simply fill in our claim form and then one of our claims agents will call you to get some further information. Once we have spoken to you we can then send you your claim forms.

Please make sure all required fields * are completed.

YOUR DETAILS
Do you pay Tax on your earnings ? *	Yes No
Title *
First Name *
Last Name *
Date Of Birth *	Day: Month: Year:
Simply Enter your postcode to automatically find your address
Postcode/Address *	Only UK Postcodes, pattern: AA1A 1AA.
Select Address *
Address Line1 *
Address Line2
City *
County *
Country *
National Insurance Number *
Re-Enter National Insurance Number *
Telephone *
Re-enter Telephone *
E-mail Address *
Confirm E-mail Address *
EMPLOYMENT HISTORY
List your employment history that you wish to claim for below (if more space is needed please put these on a separate sheet and send them back with these forms)

Job title/Industry For example: Care Worker, support worker, construction, sales rep etc.	Company Name	Start Date (Month/Year)	End Date – or write 'present' if still there(Month/Year)
*	*	*	*

Do you wear any uniform or protective clothing and have to wash them yourself for any of your employments listed? If you wish to claim an additional tax refund for these costs please tick yes ? *	Yes No
Have you been injured in any accident within the last three years that was not your fault?	Yes No

Client Testimonial

I submitted my claim and did not even know I could claim this. I sent my forms and forgot about it if I am being honest. Until i got a call and the nice gentleman asked me if I was sitting down. I first thought I was in trouble until he said how much they had got back for me. I can not thank them enough and would recommend this company to anyone. You do not have anything to lose as it is no win no fee. Great service.

- Mrs P. Tshongweni
Community Nurse

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