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Click ‘Get Form’ to open it in the editor.
Begin by entering your full name and date of birth in the designated fields. Ensure you use capital letters and write clearly.
Provide your National Insurance number, which is essential for processing your request.
In the 'Claimant’s employment history' section, specify the years you need the employment history to cover. Enter the start and end dates in the format YYYY.
Detail any employers you have worked for, including their full names and the corresponding years of employment.
Indicate the nature of your claim by selecting from options such as industrial injury or medical negligence, providing brief details as necessary.
If applicable, include any medical evidence that supports your claim before submitting the form.

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