JURY EXPENSES CLAIM FORM			
				
Name:

Address:

Personal ID Number:
(from front of citation)
		Please provide details of where and when you attended for Jury service.
Date:…………………………………..
Time:………………………………….
Place:…………………………………

CLAIM FOR TRAVELLING/FINANCIAL LOSS
If you wish to claim for travelling/financial loss, you must read the expenses guidance sheet (available on the SCTS website www.scotcourts.gov.uk/coming-to-court/jurors or from your local court) and complete this form carefully and accurately. If you are claiming loss of earnings/benefit or child-minding/dependent adult career allowance you must get your employer/the career to complete the certificate which is enclosed and return it with this claim form. If it is not enclosed then payment cannot be made. Please note: the allowances are meant to compensate you for your out-of-pocket expenses and loss of earnings or benefit. They are not meant to compensate your partner or your spouse. There is a maximum amount which can be claimed. The rate is fixed by Scottish Ministers, and is reviewed every year. 

There is no scope for any juror to be paid more than these maximum amounts.
Receipts or tickets must be attached otherwise we will be unable to pay your claim.

PLEASE COMPLETE ALL THE ABOVE INFORMATION. FAILURE TO DO SO MAY DELAY PAYMENT OF YOUR CLAIM

I declare that the information I have given on this form is correct and complete as far as I know and believe. I understand that if I knowingly give information that is incorrect or incomplete, I may be liable to prosecution or other action.
Signature
of Claimant 	 Date 	

(Please note: If you consider you need the use of a taxi, this must be approved by the clerk of court before you attend for jury service).
Travel Using Own Car/Motorcycle/Bicycle
•	Could you have travelled by public transport? YES/NO (delete as appropriate)
•	If yes, please provide reason that public transport was not used:

No. of days

Daily cost

I travelled by

Total cost claimed

Tickets attached (p)

Certificate attached (p)

Hours lost
(If paid hourly)

Total claimed

No. of days or 1/2 days lost 
(if paid daily) 

Travel by Public Transport

Rail
Bus
Taxi

No. of days

Daily cost

Return mileage

Total claimed

I travelled by

Bicycle Car or motorcycle (public transport rate) Car/motorcycle (standard rate) 

Loss of Earnings/Benefit
•	Have you suffered any loss of earnings as a result of your attendance for jury service? YES/NO (delete as appropriate)
If YES, please state: (a) your occupation:
(b) Daily or hourly rate (or equivalent): £

Mon Tues Wed Thurs Fri

Substitution/Childminder/Adult Carer
•	Have you paid any person to act as a substitute for you during your attendance for jury service? (e.g. at your place of employment, or to look after your children or a dependent adult). YES/NO (delete as appropriate)

Total claimed

Hours paid for

Certificate attached (p)

Mon Tues Wed Thurs Fri

Subsistence (can only be claimed if the court has not provided, or offered to provide, meals for you) on the days on which the court has not provided meals for you, have you necessarily incurred expenses on subsistence? YES/NO (delete as appropriate)

Totals:

DECLARATION

OFFICIAL USE ONLY
Certified correct 	
Authorised for payment 	
Date 	

No. of
days

Allowed

Total

OFFICIAL USE ONLY

£

Receipts attached (p)

Time left home/ employment

Time returned home/to employment

Was lunch provided? Yes/No

Mon Tues Wed Thurs Fri