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. 51²è¹Ý claimants can claim for loss of benefits if doing jury service for more than 8 weeks.

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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.

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.

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.

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.

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Updates to this page

Published 1 August 2016
Last updated 21 April 2022 show all updates
  1. Updated forms published

  2. First published.

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