Form TSF4
| Published date | 21 March 2018 |
Party/Witness – Claim for attending an employment tribunal
1. Your details
Surname
First name(s)
Home address
Postcode
Phone number
2. The hearing
Case number or names of the parties
Where was the hearing held?
On what date(s) did you attend?
Were you summoned to attend by a witness order?
3. Total claim and declaration
After completing each section overleaf please transfer the total here:
Net travel expenses (see Section 6) £
Overnight expenses (see Section 7) £
Other (see Section 8) £
Lost earnings (see Section 9) £
Total claim £
I declare that to the best of my knowledge all the information provide
is correct and that any expenses claimed were actually and necessarily
incurred by me.
Signed
Date
Warning: False claims may lead to prosecuton on a criminal charge.
4. Method of payment
How do you wish to receive payment?
Direct to my bank (give details at Section 5)
By crossed payable order
5. Bank details
Complete this section only if you want payment made to a Bank or
Building Society.
Name of Bank/Building Society
Address
Postcode
Name of account
Account number
Sort code
— —
Notes
• Please claim within one month of the hearing
• See our Expenses and Allowances payable leaet.
• Attach all receipts.
• Please print details clearly in CAPITAL letters and sign part 3.
• Initial any alterations you make.
• Send your completed form to the address in Section 10.
TSF4 - Party/Witness – Claim for attending an employment tribunal (07.18)
FOR HM COURTS & TRIBUNALS SERVICE OFFICIAL USE ONLY
I have delegated authority to approve this claim and conrm that:
• the claim is in accordance with the relevant HMCTS instruction;
• no item has previously been passed for payment; and
• the claim for expenses relates to an Employment Tribunal claim
made prior to 6 April 2012
Charge £
BEC NAC 226410
Signed Date
PRINT NAME
For completion by Liberata
Amount paid £
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