Form

Claim for loss of earnings during jury service - self-employed or company directors: Form 5223F

Use this form if you are self-employed, or a company director, and need to claim for earnings lost during jury service.

• From: HM Courts & Tribunals Service
• Published: 1 August 2017
• Last updated: 27 November 2023
  Show all updates

  1. 27 November 2023

     Information added about what to do if your dividends have been affected by jury service.

  2. 21 April 2022

     Updated forms published

  3. 1 August 2017

     First published.

Documents

Claim form: 5223F

PDF, 151 KB, 3 pages

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Ffurflen hawlio: 5223F

PDF, 65.3 KB, 3 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 self-employed and doing jury service.

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