Form ET1A
| Published date | 21 March 2018 |
Employment Tribunal
Claim form
1Your details
ET1A - Claim form (12.18) © Crown copyright 2018
1.1 Title Mr Mrs Miss Ms
1.2* First name (or names)
1.3* Surname or family name
1.4 Date of birth / / Are you? Male Female
1.5* Address Number or name
Street
Town/City
County
Postcode
1.6 Phone number
Where we can contact you during the day
1.7 Mobile number (if dierent)
1.8 How would you prefer us to contact you?
(Please tick only one box) Email Post Fax Whatever your preference please note that some documents
cannot be sent electro nically
1.9 Email address
1.10 Fax number
2Respondent’s details (that is the employer, person or organisation against whom you are making a claim)
2.1* Give the name of your employer or the
person or organisation you are claiming
against (If you need to you can add more
respondents at 2.5)
2.2* Address Number or name
Street
Town/City
County
Postcode
Phone number
Official Use Only
Tribunal office
Case number Date received
You must complete all questions marked with an ‘*’
2.3 Do you have an Acas early conciliation
certificate number? Yes No
Nearly everyone should have this number before they fill in a claim
form. You can find it on your Acas certificate. For help and advice,
call Acas on 0300 123 1100 or visit www.acas.org.uk
If Yes, please give the Acas early conciliation
certificate number
If No, why don’t you have this number? Another person I'm making the claim with has an Acas early conciliation certificate number
Acas doesn’t have the power to conciliate on some or all of my claim
My employer has already been in touch with Acas
My claim contains an application for interim relief (See guidance)
2.5 If there are other respondents please tick this box and put their
names and addresses here.
(If there is not enough room here for the names of all the additional
respondents then you can add any others at Section 13.)
2.4 If you worked at a different address from the one you have given at 2.2 please give the full address
Address Number or name
Street
Town/City
County
Postcode
Phone number
Respondent 2
Name
Address Number or name
Street
Town/City
County
Postcode
Phone number
To continue reading
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