Application for union legal assistance

Union legal assistance is provided in accordance with the union rules and the conditions of legal assistance. Legal assistance may be provided for members and members’ families for any accident or disease occurring outside the home in the UK and the Republic of Ireland.

There are strict time limits for claims so do not delay. The Union will appoint a solicitor who will contact you. If you have not heard within 48 hours of submitting this form, please contact your Regional Office.

The conditions of legal assistance will be sent to you once legal assistance is granted.


Please specify the type of claim	Accident at work Road accident Holiday accident Assault at work Disease Any other accident
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Personal details of the applicant
Full name
Address
Postcode
Date of birth
Sex	Male Female
Home telephone number
Mobile telephone number
Email address
Name and address of employer
Membership number
Note: If you are a member of the union member’s family, legal assistance is only available to you if you are not in work. Please provide the union member’s full name, address and their union membership number.
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Details of accident or disease
Where did your accident occur? If your claim relates to a disease, please state the place where it was contracted or where the exposure took place
Date of accident or knowledge of disease*
Please describe how your accident or disease occurred
Please describe your injuries or illness
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Authorisation*	I wish to apply for legal assistance in accordance with union rules and the conditions of legal assistance. The information I have provided on this form is accurate to the best of my knowledge

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Application for union legal assistance