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ANNEX 1
POST OFFICE LIMITED
OVERTURNED CONVICTIONS INTERIM
PAYMENTS
Application form for overturned conviction interim payment
Please read this information before completing the application form.
Please only complete one application form. Please answer all questions on the form and provide as
much detail as possible. The personal information requested in the application form enables Post
Office to conduct any relevant checks required for the purpose of progressing your application.
If any additional information is required to help progress your application, you will be contacted
about this by email.
Applications (along with any supporting material or evidence) and other communications should be
sent by email to HSFPostOfficeOC! j
In order to be eligible for an interim payment, you must have had a criminal conviction arising
from your involvement with Post Office which has now been overturned. You can apply on
behalf of another who meets these criteria provided you can demonstrate that you are authorized
to act on their behalf. If you are claiming on behalf of an insolvent estate, you must provide
evidence of your authority to act on behalf of the relevant insolvency officeholder (e.g. trustee in
bankruptcy or official receiver) or other relevant officeholder.
Please note that payments will be offered at Post Office's sole discretion and may not be offered in
all cases.
If you have any questions about interim payments, please contact HSFPostOfficeOC\ “GRO ~
POL00448912
POL00448912
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Applicant's details
1. Full name (including any middle
names)
2. Previous name(s) at time of
conviction (if any)
3. Date of birth
4. Current postal address
5. All previous addresses since date of
conviction (if different to the above
and if you have changed your
address since your conviction)
6. Email address
7. Contact telephone number
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Le, HERBERT
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SMIT
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POL00448912
POL00448912
8. What was your role in connection
with Post Office (ie postmaster,
branch assistant/manager or Crown
Office employee)? If you were not a
postmaster, please provide further
details of your role (including length
and terms).
Application on behalf of someone else
9. Are you applying on behalf of
someone else? If yes, please set out
(i) your details, and (ii) your
relationship with the applicant.
Please also attach to this application
evidence of your authority to act on
the applicant's behaif.
in order to allow us to speed up the resolution of your wider claim against POL, please
could you also supply details of your potential civil claim against Post Office
10. Do you intend to accept the £600k up-front offer announced by the Department of
Business and Trade ("the DBT Offer") instead of bringing a claim for your actual
Please note that the position you take in relation to the DBT Offer will not affect your
application for an interim payment.
losses? if you have not yet decided whether to do so or not, please state "Uncertain".
1. Unless you plan to accept the DBT Offer, please could you briefly explain what losses or
damages you intend to claim for in your civil claim and the expected value of your
claim, where known.
12.
provide any further details in respect of those claims, including the expected claim
values,
Please confirm whether you intend to claim for the specific losses set out below. Please
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HERBERT
SMITH
FREEHILLS
POL00448912
POL00448912
Did you pay any sums to POL before
the date of the audit of your PO
branch in relation to shortfalls
experienced in branch either via
deduction from remuneration or
direct payment (e.g. transferring cash
from a retail business to POL)? If so,
could you please set out the
approximate amount paid and the
approximate dates these sums were
paid?
Were you required to pay any money
at the time of or following the audit
which ultimately resulted in your
conviction (eg did you repay a
shortfall or receive a confiscation
order or a compensation order)? If
so, please provide details.
Loss of reputation (including any
loss of earning capacity) — if so,
please provide details
Loss of business or property
Personal injury or distress and.
inconvenience
Bankruptcy or insolvency related
costs or losses
Prosecution related costs or losses —
if so please specify
General damages such as loss of
liberty, exemplary damages or
aggravated damages
Were you a member of a POL
pension scheme or any other private
pension scheme? If so, please
provide details.
Any other key heads of losses - if so,
please specify
Additional Details
POL00448912
POL00448912
MWY Le, HERBERT
= = SMITH
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13.
What was your annual income (gross
of tax) prior to your prosecution?
What is your current income (gross
of tax)?
15.
Have you received any settlement
payments from Post Office in the
past (for example under Network
Transformation)? If so, please
provide details and confirm the
amount received.
16.
Do you receive any social security
benefits? If yes, please set out
details.
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17.
Have you previously been, or are you
currently subject to, any bankruptcy
process, debt relief orders, individual
voluntary arrangements (IVAs),
company voluntary arrangements
(CVAs) or any other insolvency
procedures?
if yes, please set out details,
including the details of your assigned
Bankruptcy Trustee.
wider claim?
Statement of truth
By signing this document I confirm that all
the information provided in this
application form is true and correct to the
best of my knowledge and belief.
if you are unable to print and scan this form
we will accept an electronic signature.
Please tick this box if you are submitting an
electronic signature.
Is there any further information I or yr other relevant factors } you ‘would like u us sto consider
either in connection with your interim payment application or in connection with your
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HERBERT
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ANNEX 2
INSOLVENT OR BANKRUPT APPLICANTS
FURTHER INFORMATION REQUIRED
lf an applicant is or has been the subject of any insolvency proceeding or process (including
bankruptcy, sequestration, individual voluntary arrangement (IVA), deeds of trust under Scots law,
debt relief orders and other debt management procedures, whether involving formal court
proceedings or not), please verify whether such proceeding or process has resulted in any express,
implied or deemed transfer of the claim to any other person (for example, a bankruptcy trustee,
whether or not the Official Receiver, the supervisor of an IVA or a debt management organization).
If any transfer has occurred, please obtain and provide us with evidence of your authority to submit
a claim on behalf of the transferee.
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POL00448912
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HERBERT
SMITH
FREEHILLS
ANNEX 3
REPRESENTATIVES OF DECEASED AND INCAPACITATED APPLICANTS
FURTHER INFORMATION REQUIRED
Applicant's England & Wales Scotland Northern Ireland
uation
Deceased Applicant
Deceased ° Personal ° Executor - ¢ Personal
Applicant with a representative Certificate of representative
will {including confirmation (including
executors) - from the Sheriff executors) -
Grant of Probate Court. Grant of Probate
‘or copy of will and or copy of will and
death certificate if death certificate if
probate has not the estate was
been granted worth less than
£10,000 or
passed by
survivorship.
Deceased © Personal e Executor - ¢ Personal
Applicant with no representative — Certificate of representative —
will Grant of Letters of confirmation Grant of Letters of
Administration from the Sheriff Administration
Court.
Living Applicant
Applicant has * Power of Attorney e = =Written Power of Attorney
capacity — a copy of the Mandate - a — a copy of the
power of attorney written power of attorney
mandate, signed
by the Applicant,
which
authorises a
specified person
to make an
application to
the Scheme on
the Applicant's
behalf. There is
no legally
prescribed form
for such a
mandate,
incapacitated © Lasting Power of © Continuing © Next Friend — a
Applicant — by Attorney — a copy Power of copy of a court
reason of mental of the power of Attorney (also judgment
disorder attorney known as appointing a Next
Financial Power Friend or a
* Deputyship order of Attorney) — certificate from a
— a copy of the copy of the solicitor
Deputyship order power of confirming that (i)
attorney and a the Applicant has
HERBERT
SMITH
FREEHILLS
POL00448912
POL00448912
from the Court of
Protection
copy of the
certificate of
registration for
that power of
attorney
evidencing __ its
registration with
the Office of the
Public Guardian
Intervention
Order—a copy of
the interlocutor
(ie. the court
order)
appointing the
authorised
person and
detailing the
intervention
authorised by
the court and a
copy of the
certificate of
registration of
the Intervention
Order with the
Office of the
Public Guardian
Guardianship
Order ~a copy of
the interlocutor
(ie. the court
order)
appointing him.
or her as
guardian and
detailing his or
her powers and
a copy of the
certificate of
registration of.
the guardianship
order with the
Office of the
Public Guardian
a disability, (ii)
that there is no
one appointed by
the court as a
Next Friend or
Guardian ad
Litem, and (iii)
that the named
Next Friend does
not have any
contrary interests
to the Applicant.
Guardian ad Litem
—a copy of a court
Judgment
appointing a
Guardian ad
Litem or a
certificate from a
solicitor
confirming that (i)
the Applicant has
a disability, (ii)
that there is no
one appointed by
the court as a
Next Friend or
Guardian ad
Litem, and (iii)
that the named
Guardian ad
Litem does not
have any contrary
interests to the
“Incapacitated
Applicant
‘the
Lasting Power of
Attorney — a copy
Continuing
Power of
Attorney (also
.
Applicant.
Enduring Power of
Attorney
registered with
POL00448912
POL00448912
HERBERT
SMITH
FREEHILLS
cannot manage of the power of known as the Office of Care
their financial attorney Financial Power and Protection —
affairs but is still of Attorney) — stamped copy of
mentally capable © Deputyship order copy of the the power of
(e.g. due may arise — a copy of the power of attorney from the
where the Deputyship order attorney and a Office of Care and
Applicant is from the Court of copy of the Protection and
elderly) Protection certificate of consent of the
registration for Master
that power of
attorney e — Enduring Power of
evidencing _ its Attorney -
registration with certified copy of
the Office of the the power of
Public Guardian attorney
¢ Intervention
Order —a copy of
the interlocutor
(ie. the court
order)
appointing the
authorised
person and
detailing the
intervention
authorised — by
the court and a
copy of the
certificate of
registration of
the Intervention
Order with the
Office of the
Public Guardian
© Guardianship
Order —a copy of
the interlocutor
(ie. the court
order)
appointing him
or her as
guardian and
detailing his or
her powers and
a copy of the
certificate of
registration of
the guardianship
order with the
Office of the
Public Guardian