THE LEGAL DEFENCE UNION
Legal Expenses Insurance Scheme
Claim Form
LDU Reference
 
 
Policy Type
 
 
Inception Date
 
       Date Claim Form Issued
 
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Completed Claim Forms should be returned immediately via the Insured's Appointed Representative (where appropriate) to Professor David O'Donnell.
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Notes:
A. This form must be completed if the Insured wishes to make a claim under the Legel Defence Union Policy. It must be accompanied by any relevant documentation including, where notice of intended litigation, legal proceedings or disciplinary action has been received, a copy of any summons, writ, Industrial Tribunal papers or any written communication from the Law Society of Scotland.

B. Our specific written consent must be obtained before any payment will be made under the terms of the insurance.
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1. Name of Insured
 

2. Address

 

 

 

3. Contact (name and job title)

 

 

4. Is the Insured VAT registered?   Yes  
  No  
 
5.Name and address of other party of complainant involved

 

 

6. What does this claim relate to? Tick the appropriate box/boxes

Disciplinary action
A contract of employment
Criminal proceedings

(Please advise whether the Insured is pursuing or defending the action)

7. Please give brief details of the act, omission or dispute giving rise to this claim or these legal proceedings

 

 

 

 

 

 

8. Specify the date on which the act, omission or dispute referred to in Question 7 was first committed, occurred or began

 

 

 


9. Specify the date on which the Insured first became aware of the act, omission, or dispute referred to in Question 7

 

 

10. Did the Insured realise immediately that the allegations made might lead to a claim under the policy?

Yes  
  No  
If 'NO' when did the Insured first become aware that they might lead to a claim under the policy, or if this matter relates to a dispute
with the Insured's employers, when was litigation first contemplated?

 

 

11. Please give name and address of the Appointed Representative who is to represent the insured

Firm Name

Address

 

Contact Name                                                                                                        Tel
Ref                                                                                                                          Fax

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Declaration
I/We was/were not aware at the date of inception or renewal of this insurance that this claim, the details of which are set out above,
was liable to arise.
I/We declare that the above statements are true and complete and request indemnity in accordance with the terms of issue of the
insurance.

Signature                                                                              Name

Date