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: 5 February 2026 — See all updates

Documents

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

PDF, 114 KB, 2 pages

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

PDF, 140 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.

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

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Published 1 August 2016

Last updated 5 February 2026 + show all updates

1. 5 February 2026

   Added a welsh landing page.

2. 21 April 2022

   Updated forms published

3. 1 August 2016

   First published.