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ATE Application Form

1. THE CLAIMANT
Name:  
Address:  
   
   
   
Post Code:  
Telephone:  
Occupation:  
Age:  
     
2. THE DEFENDANT
Name:  
Address:  
   
   
   
Post Code:  
Telephone:  
Solicitor:  
     
3. THE CLAIMENT'S LEGAL REPRESENTATIVE
Firm:  
Fee Earner:  
Address:  
   
   
   
Post Code:  
Telephone:  
Fax:  
E-mail:  
DX:  
     
4. THE PROCEEDINGS
Type of Case:  
Date of Incident:  
Date Solicitor Instructed:  
What is the date of the CFA?  
CFA Uplift %:  
Estimated Damages:
£
Is Counsel on a CFA?  
     
CLAIMENT    
Do they have BTE?  
Proceedings issue date:  
Part 36 Offer received/made?  
Trial Date if Known:  
     
DEFENDANT    
Are they insured?  
Is liability admitted?  
     
5. ESTIMATED COSTS
 
Claiment's Costs
Defendant's Costs
 
TOTAL TO DATE
TOTAL TO CONCLUSION /
AT TRIAL
TOTAL TO CONCLUSION /
AT TRIAL
Solicitor's Costs
Counsel's Fees
Disbursements
TOTAL
     
6. SUPPORTING INFORMATION
Witness statement(s):  
Counsel's opinion:  
Police report:  
Expert witness report(s):  
Medical evidence:  
     
Your View of Success:   %
     
7. HOW COMPLEX ARE THE LEGAL ISSUES AND THE FACTS OF THE CLAIM?
     
   
     

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