GLO COMPENSATION SCHEME: DBT REGISTRATION FORM
The information collected in this form is to collect basic information for registration only. Your
BEIS0001049
BEIS0001049
answers will be non-binding and will not by any means prejudice your full claim which will submitted
via a separate Main Application Form that will be issued in due course
DBT continues to urge postmasters to engage legal advisors who can assist you with completing this
Registration Form. DBT has agreed to meet the reasonable legal costs of members of the GLO and
has set out the tariff by which those costs will be calculated here.
Section 1: Personal Details
Personal details
Full name of claimant (and
“known as”)
Previous name if any
Date of Birth
National Insurance Number
Postal Address
Email Address(es)
Telephone Number
Legal Representative
Legal Representative Postal
Address
Section 2: Branch Details
Please complete details of the branch or branches your claim relates to.
BEIS0001049
BEIS0001049
Branch 1
Branch 2 (if applicable)
Branch 3 (if applicable)
Branch 4 (if applicable)
Branch Name
Branch Address
Dates of POL tenure
- _ First Day of Service
- Last Day of Service
Company Name (if
applicable)
Desirable information (i.e. if known by the claimant)
FAD Code
Payroll / Customer
Number
Current or former
postmaster?
Do you intend to claim for
any shortfalls from this
branch?
Y/N
Y/N
Y/N
Y/N
BEIS0001049
BEIS0001049
Search of POL Records
To the best of your knowledge, please indicate
dates in relation to which a search of POL
records should be undertaken.
HMRC Disclosure
Do you intend to request disclosure from HMRC? Y/N
GLO Participant
Please confirm here that you were a claimant in the High Court “GLO” case Y/N
(Bates v Post Office Limited) proceedings and have not been convicted of a
criminal offence related to the Horizon scandal?
Signed (claimant or
authorised
representative)
Name
Date
Consent
By signing this document, I confirm that: I consent to DBT sharing details of my application with
Post Office Ltd. for the purpose of identifying Personal Data, Special Category Personal Data and
Criminal Offence Data relevant to my claim and for that information to be shared with DBT and its
appointed representatives in relation to the GLO Compensation Scheme.
To see how DBT intends to use your data please see here:
https://www.gov.uk/government/publications/compensation-scheme-for-group-litigation-order-
case-postmasters/compensation-scheme-for-group-litigation-order-case-postmasters-privacy-notice