Employee Redundancy Payment & Insolvency Claim Form

Company Defender Advisory Ltd

If your employer has become insolvent and you are owed money from your employment, please complete this form. This form collects the information required to assess your potential entitlement to payments through the Redundancy Payments Service (RPS).

You may be able to claim amounts such as:

Statutory redundancy pay
Unpaid wages
Holiday pay
Certain commission or overtime payments
Statutory notice pay

Please provide accurate information and upload supporting documents where available.

Please do not complete this form on behalf of the company. This form is for employees/former employees only.

Section 1 — Your Personal Details

1. First name *

2. Surname *

3. Previous surname, if applicable

4. Date of birth *

5. National Insurance number *

6. Email address *

7. Mobile telephone number *

Section 2 — Your Address

8. Address *

9. Town/City *

10. Postcode *

Section 3 — Your Former Employer

11. Name of your employer *

12. Your job title *

13. Date you started working for the employer *

14. Date your employment ended *

15. Were you made redundant?

16. If you were made redundant, what date were you told?

17. What was the reason given for ending your employment?

Section 4 — Insolvency Details

18. Has your employer entered insolvency proceedings?

19. Do you have an RPS/CN case reference?

20. CN reference

21. Have you been contacted by the Insolvency Service or an Insolvency Practitioner?

22. Name of Insolvency Practitioner/Official Receiver, if known

23. Upload any letter/email you have received about the insolvency

Click to upload files

Section 5 — Your Pay

24. How were you normally paid?

25. What was your normal gross pay? *

26. Was your pay fixed or variable?

27. Were you paid overtime?

28. Were you paid commission?

29. Were you entitled to bonuses?

30. Upload your most recent payslips

Click to upload files

Section 6 — Unpaid Wages

31. Does your former employer owe you unpaid wages?

Section 7 — Holiday Pay

36. Are you owed holiday pay?

Section 8 — Redundancy Pay

40. Have you received any redundancy payment from your employer?

42. Have you previously made a redundancy payment claim?

43. Do you believe you are owed statutory redundancy pay?

Section 9 — Notice Pay

44. Did you receive payment for your notice period?

45. What was your contractual notice period?

46. How much notice did you actually work?

47. Did you receive any wages from another employer during your notice period?

Section 10 — Other Money Owed

49. Does your former employer owe you any other money?

Section 11 — Employment Documents

53. Upload your employment contract

Click to upload files

54. Upload your redundancy/dismissal letter

Click to upload files

55. Upload payslips

Click to upload files

56. Upload P45/P60, if available

Click to upload files

57. Upload holiday records

Click to upload files

58. Upload correspondence with your former employer

Click to upload files

59. Upload correspondence from the Insolvency Practitioner/Official Receiver

Click to upload files

Section 12 — Bank Details

60. Account holder name *

61. Bank/building society name *

62. Sort code *

63. Account number *

64. Building society roll number, if applicable

Section 13 — Declaration

65. Employee declaration *
I confirm that the information I have provided is true and accurate to the best of my knowledge. I understand that further information or supporting documentation may be requested to verify my claim.

66. Authority to assist *
I authorise Company Defender Advisory Ltd to review the information and documents provided by me for the purpose of assessing and assisting with my employment-related insolvency claim and, where instructed, assisting me with the Redundancy Payments Service process.

67. Full name *

68. Date *