This form contains 65 fields organized into 28 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Applicant Name/Firm
Applicant Name or Firm Text
Provide your full name, or if you are a legal representative, the name of your firm.
Applicant Role
Claimant Checkbox
Check this box if the applicant is a claimant in the case.
Defendant Checkbox
Check this box if the applicant is a defendant in the case.
Legal Representative Checkbox
Check this box if the applicant is acting as a legal representative for a party in the case.
Other Role Specification Text
Please specify your role if it is not Claimant, Defendant, or Legal Representative. Fill only if 'Other (please specify)' is 'Yes'.
Depends on: Other (please specify)
Other (please specify) Checkbox
Check this box if the applicant's role is not Claimant, Defendant, or Legal Representative, and then specify the role.
Applicant's Address
Building and Street Text
Enter the building number, name, and street name for the applicant's address.
Second Line of Address Text
Provide any additional address details, such as apartment number, floor, or unit.
Town or City Text
Enter the town or city of the applicant's address.
County Text
Provide the county for the applicant's address, if applicable.
Postcode Text
Enter the postcode for the applicant's address.
Application Handling Preference
At a hearing Checkbox
Check this box if you want the application to be dealt with in person at a court hearing.
Without a hearing Checkbox
Check this box if you want the application to be decided by a judge without a formal hearing.
At a remote hearing Checkbox
Check this box if you want the application to be dealt with remotely, such as via video or telephone.
Claimant's Name
Claimant's Name Text
Enter the full name of the claimant, including any relevant reference information.
Contact and Reference Information
Phone Number Text
Please enter the primary contact phone number.
Fax Phone Number Text
Please enter the fax phone number, if applicable.
DX Number Text
Please enter the DX (Document Exchange) number. Fill only if 'Are you a' is 'Legal Representative'.
Depends on: Legal Representative
Your Reference Text
Please enter your internal reference number for this matter. Fill only if 'Are you a' is 'Legal Representative'.
Depends on: Legal Representative
Email Text
Please enter the contact email address.
Court and Claim Number
Name of Court Text
Provide the name of the court where this application is being filed.
Claim Number Text
Provide the unique claim number associated with this application.
Date
Date Date
Please enter the date.
Day Text
Provide the day of the date. Fill only if 'What information will you be relying on, in support of your application?' is filled
Depends on: Attached witness statement, Statement of case, Evidence set out in the box below, Details of Evidence
Month Text
Provide the month of the date. Fill only if 'What information will you be relying on, in support of your application?' is filled
Depends on: Attached witness statement, Statement of case, Evidence set out in the box below, Details of Evidence
Year Text
Provide the year of the date. Fill only if 'What information will you be relying on, in support of your application?' is filled
Depends on: Attached witness statement, Statement of case, Evidence set out in the box below, Details of Evidence
Defendant's Name
Defendant's Name Text
Please provide the full name of the defendant, including any relevant reference.
Draft Order Attachment Status
Yes Checkbox
Check this box if you have attached a draft of the order you are applying for.
No Checkbox
Check this box if you have not attached a draft of the order you are applying for.
Fee and Reference Numbers
Fee Account Number Text
Please provide the fee account number if applicable.
Help with Fees Reference Number Part 1 Text
Please enter the first part of the Help with Fees reference number.
Max length: 3 characters
Help with Fees Reference Number Part 2 Text
Please enter the second part of the Help with Fees reference number.
Max length: 3 characters
Fixed Trial Date/Period
Fixed Trial Date/Period Details Text
Provide specific information regarding any fixed trial date or period.
General
cOlsFy Text
61jTaD Text
nKRpZh Text
zTbk0o Text
RZjrSh Text
Hearing Duration Estimate
Estimated Hours Number
Please provide the estimated duration of the hearing in hours. Fill only if 'At a hearing' is 'Yes'.
Depends on: At a hearing
Estimated Minutes Number
Please provide the estimated duration of the hearing in minutes. Fill only if 'At a hearing' is 'Yes'.
Depends on: At a hearing
Help with Fees Reference Number
HWF Reference Number Segment 1 Text
Please enter the first numeric segment of the HWF reference number, following 'HWF-'.
Page 2
Attached witness statement Checkbox
Check this box if you will be relying on the attached witness statement to support your application. Fill only if 'What order are you asking the court to make and why?' is filled
Depends on: Order Details
Statement of case Checkbox
Check this box if you will be relying on the statement of case to support your application. Fill only if 'What order are you asking the court to make and why?' is filled
Depends on: Order Details
Evidence set out in the box below Checkbox
Check this box if you will be relying on the evidence provided in the box below to support your application. Fill only if 'What order are you asking the court to make and why?' is filled
Depends on: Order Details
Details of Evidence Textarea
Provide a detailed description of the evidence or information you are relying on in support of your application. Fill only if 'Evidence set out in the box below' is 'Yes'.
Depends on: Evidence set out in the box below
Page 3
Yes Checkbox
Check this box if you believe you, or a witness who will give evidence on your behalf, are vulnerable in a way the court needs to consider, and you will provide an explanation.
Vulnerability Explanation Textarea
Provide a detailed explanation of any vulnerabilities you or a witness may have, and describe the steps, support, or adjustments you wish the court and the judge to consider. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
No Checkbox
Check this box if you do not believe you, or a witness who will give evidence on your behalf, are vulnerable in any way which the court needs to consider.
Parties to be Served
Parties to be Served Text
Enter the names of the parties who should be served with this application.
Represented Party
Represented Party Name Text
Enter the full name of the party you are representing as a legal representative. Fill only if 'Legal Representative' is 'Yes'.
Depends on: Legal Representative
Requested Court Order
Order Details Textarea
Please provide a detailed explanation of the specific court order you are requesting and the reasons for your request.
Required Judge Level
Judge Level Text
Specify the required level of Judge for your hearing. Fill only if 'At a hearing' is 'Yes'.
Depends on: At a hearing
Service Address
Service Address Textarea
Please provide the service address of any party named in question 9, other than the claimant or defendant. Fill only if 'Parties to be Served' is filled.
Depends on: Parties to be Served
Signatory Identification
Signatory Full Name Text
Please provide the full name of the person signing this document. Fill only if 'What information will you be relying on, in support of your application?' is filled
Depends on: Attached witness statement, Statement of case, Evidence set out in the box below, Details of Evidence
Legal Representative's Firm Name Text
Please provide the name of the applicant's legal representative's firm. Fill only if 'Applicant's legal representative' is 'Yes'.
Depends on: Applicant's legal representative
Signatory Position/Office Text
Please provide the position or office held by the signatory if signing on behalf of a firm or company. Fill only if 'Applicant's legal representative' is 'Yes'.
Depends on: Applicant's legal representative
Signatory Role
Applicant Checkbox
Check this box if the signatory is the applicant. Fill only if 'What information will you be relying on, in support of your application?' is filled
Depends on: Attached witness statement, Statement of case, Evidence set out in the box below, Details of Evidence
Litigation friend Checkbox
Check this box if the signatory is a litigation friend, applicable when the applicant is a child or a Protected Party. Fill only if 'What information will you be relying on, in support of your application?' is filled
Depends on: Attached witness statement, Statement of case, Evidence set out in the box below, Details of Evidence
Applicant's legal representative Checkbox
Check this box if the signatory is the applicant's legal representative, as defined by CPR 2.3(1). Fill only if 'What information will you be relying on, in support of your application?' is filled
Depends on: Attached witness statement, Statement of case, Evidence set out in the box below, Details of Evidence
Signature
Signature Text
Please enter your full name as your signature for this statement of truth. Fill only if 'What information will you be relying on, in support of your application?' is filled
Depends on: Attached witness statement, Statement of case, Evidence set out in the box below, Details of Evidence
Statement of Truth Selection
I believe Checkbox
Check this box if you, as the signatory, believe that the facts stated in section 10 and any continuation sheets are true. Fill only if 'What information will you be relying on, in support of your application?' is filled
Depends on: Attached witness statement, Statement of case, Evidence set out in the box below, Details of Evidence
The applicant believes Checkbox
Check this box if you are signing on behalf of the applicant, confirming the applicant believes the facts stated in section 10 and any continuation sheets are true, and you are authorized to sign this statement. Fill only if 'What information will you be relying on, in support of your application?' is filled
Depends on: Attached witness statement, Statement of case, Evidence set out in the box below, Details of Evidence
Time Estimate Agreement
Yes Checkbox
Check this box if the time estimate for the hearing duration is agreed upon by all parties. Fill only if 'At a hearing' is 'Yes'.
Depends on: At a hearing
No Checkbox
Check this box if the time estimate for the hearing duration is not agreed upon by all parties. Fill only if 'At a hearing' is 'Yes'.
Depends on: At a hearing
Warrant Number
Warrant Number Text
Please provide the warrant number, if applicable.