YOUR CLAIM FALLS IN TO WHICH OF THE FOLLOWING CATEGORIES (Tick more than one box if appropriate):
A. WRONGFUL ARREST OR FALSE IMPRISONMENT B. ASSAULT/BATTERY C. TRESPASS TO PROPERTY D. TRESPASS TO GOODS E. MALICIOUS PROSECUTION F. MISFEASANCE IN PUBLIC OFFICE G. NEGLIGENCE H. HUMAN RIGHTS ACT CLAIM I. OTHER (Please state below):
PLEASE PROVIDE THE FOLLOWING INFORMATION:
1. DATE, TIME, AND PLACE OF INCIDENT GIVING RISE TO YOUR CLAIM:
2. BRIEFLY SET OUT WHAT HAPPENED AND WHY YOU BELIEVE YOU MAY HAVE A CLAIM:
3. WERE YOU CONVICTED OF ANY OFFENCE ARISING OUT OF THE INCIDENT ? IF SO, WHAT OFFENCE AND WHEN? (State which court)
4. STATE THE POLICE FORCE THIS MATTER INVOLVES:
5. DID ANY SOLICITORS ACT FOR YOU IN THE CRIMINAL PROSECUTION? IF SO PLEASE PROVIDE THEIR NAME AND ADDRESS AND IF POSSIBLE THEIR CASE REFERENCE NUMBER.
6. PLEASE STATE IF YOU ARE WORKING OR CLAIMING BENEFITS:
