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GLO COMPENSATION SCHEME APPLICATION FORM
Full Name of Claimant:
Unique DBT GLO Scheme Reference Number: [To be issued by DBT following Registration Form]
Application on behalf of a postmaster, partnership or a limited company
1. Are you applying on behalf of a postmaster? If yes, please out (i) their details, and (ii) your
relationship with them. Please see the guidance issued by DBT alongside this form to who can
bring an application on behalf of another person. As part of this application, you must
provide proof as to your legal capacity to make an application on their behalf.
Branch and role details — Further to the details provided in Section 2 of the Registration Form
please provide the following details of all branches you have been associated with.
2, What is/was your role (e.g. postmaster, directly managed branch employee, absent
postmaster, temporary postmaster)? If your role has changed over time, please list the
different roles and the relevant dates for each.
3. Did you employ assistants/staff at the branch?
If yes, please provide details, including names and dates of appointment (if known), including
whether they are still employed.
Further, if their employment has ended, please provide any details if known if the matter is
relevant to your claim.
Losses Claimed — Please fill out all which are applicable. Before completing this section, please
note that further guidance in addition to the details provided below can be found here:
https://www gov.uk/government/publications/compensation-scheme-for-group-litigation-order-
case-postmasters
As per section 4,2 in the guidance, given the tax exemption provided by HMT all claims should be
provided net of tax. if you are unable to work out the net calculation, please state that your claim
has been made gross of tax and DBT will make the relevant after-tax deductions.
BEIS0001050
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GLO COMPENSATION SCHEME APPLICATION FORM
4. Shortfalls paid to Post Office Ltd. (POL)
Please provide the total value of the shortfalls in respect of which you are applying.
This should be made by reference tothe Claimant’s Schedule of Core Information (SOCI) used in
the GLO legal proceedings for any breakdown.
If there are any additional shortfalls in respect of which you are applying which are not induded
in the SOCI, details of these should be provided. This should include if known:
1L. The amount;
2. The relevant dates (please specific when any shortfall was first noticed and when it was first
settled [if applicable];
3. Whether the shortfall amount was paid to Post Office (along with the date and value of any
Payment);
4. How the shortfall amount was paid to Post Office (along with the date and value of any
Payment);
5. Whether Post Office was notified of any shortfall and, if so, how and when it was notified.
In particular, please provide details of:
- Any relevant reference numbers;
- Any advice given by Post Office to deal with any shortfalls; and
- Who within Post Office advised you (if known);
6. Any other relevant information in relation to any shortfall — e.g. please detail whether
shortfalls arose as a consequence of any specific transaction or type of transaction.
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GLO COMPENSATION SCHEME APPLICATION FORM
5. Loss of earnings during suspension
Were you suspended from your position at any time? If yes, please provide:
- the dates of your suspension
- the reasons given by POL for the suspension
- Whether the suspension was with or without pay
- _ The total value of lost earnings from POL you are claiming for the suspension period
GLO COMPENSATION SCHEME APPLICATION FORM
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6. Loss of earnings for failure to give notice (termination)
Was your contract with the Post Office terminated? If yes, please provide:
- the date of your termination
- the reasons given by POL for the termination. If you were forced to resign as a result of
alleged shortfalls(s) this should be noted here.
- Whether POL’s decision to terminate your contract was with or without notice.
- the total value of lost earnings from POL you are claiming for POL’s failure to give
appropriate notice
7. Loss of earnings post-termination
Please provide the total value and details of lost eamings post-termination that you are
applying for.
If you obtained alternative employment / received an income following the suspension and/or
termination, please provide:
- confirmation of the date on which you were re-engaged or obtained employment
- _ details of the remuneration received, or income earned thereafter
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GLO COMPENSATION SCHEME APPLICATION FORM
8. Loss of Profits
Please provide the total value and details of any loss of profits from the Post Office branch or
any retail shop owned by you associated with the Post Office branch. This should include a
calculation showing how the amount claimed has been quantified.
9. Loss of Property or Other Assets
If, as the result of Horizon Shortfalls, you were forced to dispose of an asset (e.g. a property) at
a loss which you otherwise would have retained, compensation for this may be available.
Please provide the total value and details of the claim. This should include a calculation showing
how the amount claimed has been quantified.
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GLO COMPENSATION SCHEME APPLICATION FORM
10. Loss of Opportunity / Chance
Compensation for loss of an opportunity / chance may be available if there was a course of
action which could have resulted in financial gain, such as expanding your business or making
other investments, which you would have pursued if not for Horizon Shortfalls.
Please provide the total value and details of the claim. This should include a calculation showing
how the amount claimed has been quantified
11, Penalties or General / Increased Cost of Financing
Were there any finandal penalties or general / increased costs of financing that you had to pay
as a result of Horizon Shortfalls (e.g. additional interest or loan arrangement fees)? If so, these
may be recoverable.
Please provide the total value and details of the claim. This should include a calculation showing
how the amount claimed has been quantified
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GLO COMPENSATION SCHEME APPLICATION FORM
12, Bankruptcy / insolvency-related losses
If you or your company been placed into any bankruptcy or insolvency processes or been the
subject of any arrangements with creditors (induding through a debt relief order, IVA or CVA) as
a result of Horizon Shortfalls, you may be entitled to claim bankruptcy / insolvency-related
losses (including fees).
If so, please confirm:
- which processes or arrangements have been undertaken; and
- the start and, if applicable, end dates of any such processes or arrangement.
- The total value of your claim. This should include a calculation showing how the amount
claimed has been quantified
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GLO COMPENSATION SCHEME APPLICATION FORM
13. Legal and professional fees
Fees incurred in relation to dealing with a Horizon Shortfall at the time it arose (e.g. the cost of
defending civil / criminal legal proceedings or professional advice about restructuring your
business) may be recoverable. You should not include fees in respect of your application to this
scheme.
Please provide the total value and details of the claim. This should include a calculation showing
how the amount claimed has been quantified.
14. Stigma/reputational damage
Have you suffered a financial loss as a result of damage to your reputation caused Horizon
Shortfalls (e.g. if customers stopped supporting the postmaster’s business as a result of the
Horizon Shortfall)?
Please provide the total value and details of the claim. This should include a calculation showing
how the amount claimed has been quantified.
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GLO COMPENSATION SCHEME APPLICATION FORM
15. Personal Injury
You may be able to claim consequential losses for personal injury suffered as aresult of a
Horizon Shortfall. Personal injury can indude physical injuries as well as psychiatric harm.
Please provide the total value and details of the claim. Amounts will be awarded in line with the
Judicial College guidelines for personal injury’. You should set out the amounts being claimed with
reference to these guidelines.
16. Handicap on open labour market
Further to the above, if following your personal injury as a result of Horizon Shortfalls you have
been disadvantaged in seeking employment in the labour market, you may be entitled to make
adaim.
Please provide the total value and details of the claim. This should include evidence of what
employment opportunities you have pursued and difficulties you have faced.
1
https://uk.practicallaw.thomsonreuters.com/Browse/Home/Books/Judicial? transitionType=Default&contextD
ata=(sc. Default) &firstPage=true
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17, Harassment
If POL’s conduct towards you was “unreasonable and oppressive”, you may be able to daim
consequential losses for the harassment you have suffered as a result of a Horizon Shortfall.
Please provide the total value and details of the claim. This should include details of what POL
did, how often it occurred and its impact on you.
18. Malicious Prosecution (Criminal or Civil)
If POL prosecuted you because of a Horizon Shortfall but you were not convicted as a result or
attempted to recover alleged losses via civil proceedings, you may be entitled to make a daim.
Please provide the total value and details of the claim.
Please note, postmasters who were convicted and subsequently had their convictions overturned
are eligible for compensation via POL’s Overturned Historical Conviction compensation
programme.
GLO COMPENSATION SCHEME APPLICATION FORM
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19, Loss of investment in branch and any connected business
Please provide the total value and details of any losses in investments you have made into the
branch or any connected business that you are applying for. This could include for example the
installation or purchase of new kit, refurbishments etc.
20. Any other losses
Please indude details of any other losses in which you are applying for.
This could include for example:
Staff redundancy (inc. tribunal claims)
Loss of value in other tangible property (jewellery, car)
Pension investment losses (existing and future)
Losses suffered by family members.
Debt related losses
Loss of savings/retirement funds
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GLO COMPENSATION SCHEME APPLICATION FORM
POL Investigations — Please fill in below details of POL’s investigations into the issues you raised
with Horizon and actions taken by POL as a result.
21. Did Post Office conduct an audit into the relevant branch? If yes, for each audit, please
provide details including:
- What prompted the audit (if known);
- The date(s) of the audit; and
- The outcome(s).
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GLO COMPENSATION SCHEME APPLICATION FORM
22, Was there any other investigation into the alleged shortfall(s) by either POL or any other
organisation / individual? If yes, please provide details, including:
- Whether any such shortfalls were reported to POL as part of any investigation and, if so,
what happened;
- Whether the Claimant was required to attend an interview with POL and/or the police
- Whether any intervention support visits were carried out;
- Whether POLsearched your home or private property;
- Whether any further training was provided following the reporting of a shortfall(s); and
- What steps were taken in respect of the branch (e.g. it was closed, records removed, a
temporary postmaster was appointed, etc).
23, What impact has your experience with POL had on your family member(s). Please provide
any details you feel are relevant / pertinent to your claim.
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Miscellaneous matters
24, Are you aware of anyone else who works/worked in the branch who is/was the subject of
dvil or criminal proceedings relating to shortfalls? If yes, please give brief details.
25. Did you participate in the Initial Complaint Review and Mediation Scheme commenced in
2013 in which complaints were reviewed by Second Sight? If yes, was a settlement agreed?
Please provide details of any settlement amount received.
26. Please provide details of any settlement amount received as part of the High Court “GLO”
case (Bates v Post Office Limited).
27, Please provide details of any interim payment received from DBT following the GLO
settlement.
28. Did you participate in a settlement/restructure as a result of Network Transformation or
other scheme? If yes, on what terms did you settle? Please provide details of any settlement
amount received.
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GLO COMPENSATION SCHEME APPLICATION FORM
Other information related to your application
29. Please list what documents/material you have or intend to provide to support your
application. If possible, please provide this scanned (or photographed) material at the same
time you submit your application. This will allow your application to be investigated and
considered more efficiently.
For postal applications, please use Royal Mail as PO Box addresses can only accept post from
Royal Mail and not from other carriers or couriers. Please send in copies of the
documents/material rather than original documents, which should be retained for your own
records. We advise using a trackable service such as Royal Mail Special Delivery when sending
documents by post.
If any additional information is required to help progress your application, you will be contacted
about this.
30. Please list what expert evidence you have / intend to provide to support your application?
DBT will consider applications for expert evidence as set out in the Tariff of Reasonable Legal
Costs’.
https://assets.publishing.service.gov.uk/government/uploads/system/uploads /attach ment_data/file/1135822
/elo-tariff-reasonable-costs.pdf
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GLO COMPENSATION SCHEME APPLICATION FORM
Statement of truth
By signing this document, I confirm that:
L All of the information provided in this application form is true and correct to the best of
my knowledge and belief; and
2 Ihave read and understood the terms of reference for this scheme as set out in the
Scheme Process published 7 December 2022.
As we are advising applicants to submit this form online rather than post, if you are unable to
print and scan this form we will accept an electronic signature — this can include simply typing in
your name in both the ‘Signed’ and ‘Name’ box below.
Signed
Date
Name
GLO COMPENSATION SCHEME APPLICATION FORM
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If there is any further information you would like to be considered when assessing your
application, please use the box below.
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GLO COMPENSATION SCHEME APPLICATION FORM
Submission of claim
Your lawyer will be granted access to the Dentons Direct platform in order to upload claims. You will
be granted access if you choose not to be legally represented.
If you are legally unrepresented and do not have access to the internet, you can send your
application form by post to:
Horizon GLO Compensation Scheme
C/O Dentons UK and Middle East LLP
1 Fleet Place
London EC4M 7WS
If you send your application via courier, the following address should be used:
Horizon GLO Compensation Scheme
C/O Dentons UK and Middle East LLP
1 Fleet Place
London EC4M 7RA.
Please include reference "DSB/RZF/TSO79928,00001" in all postal submissions.