MEMBERS AND FAMILY APPLICATION
FOR LEGAL ASSISTANCE FOR UK ROAD ACCIDENTS (ELS1)

BEFORE APPLYING TO THE GMB FOR LEGAL ASSISTANCE IN MAKING A CLAIM FOR COMPENSATION, PLEASE READ THE FOLLOWING UNDERTAKINGS CAREFULLY.

THIS FORM WILL BE E-MAILED DIRECTLY TO HELEN BAROUR IN THE LEGAL DEPARTMENT. IF YOU DO NOT GET AN ANSWER WITHIN 28 DAYS, PLEASE CONTACT HELEN AT THE REGIONAL OFFICE.

THERE IS USUALLY A THREE YEAR TIME LIMIT FOR MAKING CLAIMS, HOWEVER IF YOU ARE IN ANY DOUBT PLEASE CONTACT THE LEGAL DEPARTMENT.

I hereby apply to the Union for legal assistance in making a claim compensation.
If the application is granted, I authorise the Union to proceed with my claim and start court proceedings if appropriate.

I undertake that:

  1. The information in this form, and any information I might provide the Union, its Lawyers, Doctors, Consultant Engineers or other experts, is and shall be correct to the best of my knowledge and belief;
  2. I shall accept and act upon the advice of the Union's Lawyers and representatives, and shall co-operate fully with them, including attending all arranged appointments and replying to correspondence; and
  3. If I am granted legal assistance, and if I obtain damages or compensation, I agree to pay to the Union an Administration Charge on such basis as may be determined by the Central Executive Council from time to time. I hereby authorised the Solicitor appointed by the Union to endorse my name on any cheque in my favour in respect of the damages or compensation which may be recovered. I consent to such Solicitor deducting the Administration Charge and making payment thereof to the Union; and I instruct him/her to account to me for the balance after such deduction.
In the event of any failure by me to observe any of these undertakings, I acknowledge that I may be held personally liable for payment of legal costs and expenses attributable to such failure, and that legal assistance may be terminated. I authorise the Union and its Solicitors to deduct from any damages or compensation recovered on my behalf any such costs and expenses and any arrears of contributions due myself or (if the Applicant is not the Member) from the Member.

Please tick the box to confirm you accept the terms and conditions as above

SECTION 1 - MEMBER'S DETAILS

Title First Name Surname

Membership Number (if known) Daytime Telephone Number

SECTION 2 - DETAILS OF PERSON INVOLVED IN ACCIDENT

Title First Name Surname

Claimants Address

Telephone Number

Relationship to member if the person who had the accident is NOT a Member

 

SECTION 3 - DETAILS OF ACCIDENT

Date of accident

What is your injury

You must print a copy of this form for your own reference, click on the printer button at the top of the page or alternatively go to File, and Print. You can additionally save a copy onto your computer by going to File, Save As and then selecting a folder and file name.

Your request will now be processed and forwarded to our solicitors who will be in touch with you within 6-8 weeks to arrange a meeting to gather further information.

The form is sent via your email address which must be typed in the box.