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Judicial review claim - criminal injuries compensation cases, England and Wales

Document Cited in Related
Published date21 March 2018

UPPER TRIBUNAL

ADMINISTRATIVE APPEALS CHAMBER

For Upper Tribunal use only

Upper Tribunal Reference No.

Judicial Review claim form

(Criminal Injuries Compensation Case)

Date received

Notes for guidance are available which explain how to complete the judicial review claim form. Please read them carefully before you complete the form.

Please

Use black ink and complete the form in CAPITAL LETTERS

Use another sheet of paper if there is not enough space for you to say everything.

(Please put your full name at the top of the sheet.)

SECTION 1 – IDENTIFICATION OF THE APPLICANT

This application for judicial review is made by – (Please tick the appropriate box)

the claimant (i.e., the person who claimed criminal injuries compensation)

or

the Criminal Injuries Compensation Authority

SECTION 2 – DETAILS OF THE CLAIMANT

Claimant’s name

Address

Postcode

Telephone No.

Fax No.

E-mail address

Is the claimant represented?If so please give the representative’s details below.

Representative’s name

Address

Telephone No.

Fax No.

E-mail address

SECTION 3 – DETAILS OF THE DECISION TO BE JUDICIALLY REVIEWED

What was the date of the First-tier Tribunal's decision?

(This will also be on the decision notice.)

What was the First-tier Tribunal's (and CICA’s) reference number?

If the decision was made at or following a hearing, where did the hearing take...

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