Form

Claim for loss of earnings or benefits during jury service: Forms 5223C and 5223D

Claim for loss of earnings if your employer is not paying you during jury service. Benefits claimants can claim for loss of benefits if doing jury service for more than 8 weeks.

• From: HM Courts & Tribunals Service
• Published: 1 August 2016
• Last updated: 21 April 2022 — See all updates

Documents

Claim for loss of earnings during jury service: Form 5223D

PDF, 591 KB, 2 pages

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Claim for loss of earnings during jury service: Form 5223D (large print)

PDF, 146 KB, 3 pages

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Hawlio am enillion a gollwyd yn ystod gwasanaeth rheithgor

PDF, 60.7 KB, 2 pages

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If you use assistive technology (such as a screen reader) and need a version of this document in a more accessible format, please email hmctsforms@justice.gov.uk. Please tell us what format you need. It will help us if you say what assistive technology you use.

Claim for loss of benefits after 8 weeks of jury service: Form 5223C

PDF, 140 KB, 2 pages

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Hawlio am fudd-daliadau a gollwyd yn dilyn 8 wythnos o wasanaethu ar reithgor

PDF, 48.6 KB, 2 pages

This file may not be suitable for users of assistive technology.

Request an accessible format.

If you use assistive technology (such as a screen reader) and need a version of this document in a more accessible format, please email hmctsforms@justice.gov.uk. Please tell us what format you need. It will help us if you say what assistive technology you use.

Details

Find out more about:

• what you can claim if you’re an employee
• what you can claim if you’re not working

More information for employers on:

• giving staff time off for jury service

Find out how HM Courts and Tribunals Service uses personal information you give when you fill in a form.

Published 1 August 2016

Last updated 21 April 2022 + show all updates

1. 21 April 2022

   Updated forms published

2. 1 August 2016

   First published.