Form 37.2-B

[Form of citation of juror]

COURT OF SESSION JUROR’S CITATION

Citation Number:					Date:

To:							Time:

							Place:

Name of case:

You are cited to attend personally on the date and at the time and place stated above, and on such succeeding days as may be necessary to serve, if required, as a juror.  If you fail to attend, you will be liable to the penalty prescribed by Law.

Sheriff Clerk Depute

Please read the enclosed leaflets carefully BEFORE attending court for selection.

Expenses:  Claims for loss of earnings and/or expenses should be made at the end of your jury service.  You will be provided with an envelope for return of the completed form, and payment will be made by crossed cheque to your home address, seven to ten days from receipt of the claim.

YOU MUST BRING THIS CITATION WITH YOU TO COURT

If you wish to apply for exemption or excusal from jury service, please complete this form and return it as soon as possible to:  Deputy Principal Clerk of Session, Court of Session, 2 Parliament Square, Edinburgh EH1 1RQ.

DECLARATION:  Please state why you are applying for exemption or excusal from jury service:

[    ]  Age:		I am …………. years of age.  My date of birth is ……………

[    ]  Occupation:	I am employed as ………………………………………… and
			therefore statutorily exempt from service.

[    ]  Medical Condition:	I am medically unfit for jury service and enclose a medical certificate from my doctor.

[    ]  Special Reason:		…………………………………………………………

N.B. Should you be excused from jury service on this occasion, a further juror’s citation may be sent out to you within twelve months.

I declare that the foregoing information is correct and acknowledge that I may be asked for proof of any statement made above.

Signature  …………………………………………….  Date  ……………………….

If you have any queries telephone 0131 225 2595.  Please quote citation number and date of attendance.

Unfortunately there are no facilities for car parking at or near the court.

CERTIFICATE OF LOSS OF EARNINGS OR PAYMENT TO SUBSTITUTE/
CHILDMINDER

(OR LOSS OF NATIONAL INSURANCE BENEFIT)

I certify that for each day M ………………………………………………………….
is required by the Court for Jury Service a *deduction/charge of £ ………… per day (…………. hours @ …………. per hour) will be made from his/her* (earnings/ benefit/service supplied)

Name and Address of Employer/Substitute/Childminder or Local Office where benefit is received
…………………………………………………………………………………………
Date …………………….. Signature …………………………………………………

	OFFICIAL USE ONLY
*(delete as applicable)
	
	Allowed	No. of days	Total	
TRAVELLING
By public transport
(a)	Say whether rail, bus &c …………………………
(b)	Daily return fare £ ………………………………..
In own car, &c
(a)	Car, m/cycle &c …… Engine capacity …….. c.c.
(b)	Daily mileage (round trip) ……………………….
(c)	Could you have travelled by public transport?  *YES/NO
If YES, indicate how much time was saved by using your own vehicle.
	£______p		£______p	
SUBSISTENCE
On the days on which the court has NOT provided meals for you, have you necessarily incurred expenses on subsistence? 
*YES/NO

If YES, give number of hours, including travelling time you were away from your home or place of business.
(If you attended Court on more than one day, show the number of hours for each day)
………………………………………………………………….
				
LOSS OF EARNINGS (only refundable if certified above)
Will you suffer any loss of earnings as a result of your attendance for jury service?		               *YES/NO

If YES, please state
(a)	your occupation ………………………………….
(b)	daily or hourly rate (or equivalent) £ …………….
(c)	number of days and half-days lost ………………. 
Have you paid any person to act as a substitute for you during your attendance for jury service (e.g. at your place of employment, or to look after your children &c)? 	*YES/NO

If YES, please state
(a)	capacity in which paid substitute employed ………
(b)	his/her daily or hourly rate £ ……………………...
(c)	number of days and half-days paid substitute employed ………………………………………….				
I DECLARE that to the best of my knowledge and belief the particulars in the foregoing claim are correct
				
TOTALS				
…………………………………..………. Signature of Claimant				

RECEIVED the sum of
£ ………………………………….
(Signature) ……………………….
(Date) …………………………….

FOR OFFICIAL USE ONLY

CERTIFIED CORRECT …………………………..
AUTHORISED FOR PAYMENT …………………
DATE ………………………………………………