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Application for a fee remission Protect Personal Data EX160Documentary evidence is required in support of your fee remission application. Failure to provide the correctevidence will result in your application being refused. Please complete in black ink and CAPITAL LETTERS

1. About the case For Probate cases only

Case or claim number(leave blank if this is a new

case/claim

Name of deceased

What is the title or numberof the form you need theCourt to issue?

Name of claimant(s)/petitioner(s)

Date of deathName of defendant(s)/respondent(s)

2. Your details

Gender Male Female Your address

Surname/family name

First and middle names

Date of birth Postcode What is your status? Single person Part of a couple

Do you have any children? Yes No If Yes, how many are financially dependent on you? 3. Remission 1 full remission based on receipt of a specified benefit

Do you receive any of thesebenefits

Income-basedJobseekers Allowance

Working Tax Credit and not receivingChild Tax Credit

Income-related Employmentand Support Allowance

You must provide correctly dateddocumentary evidence to showyou receive one of these benefits.

Income Support Pension Credit guarantee credit

None of the above Go to section 4 If you have ticked any of the above boxes Go to Section 6

4. Remission 2 full remission based on gross annual income

What is your gross annualincome?

Applicant Partner

Gross annual income is yourtotal annual income before taxand other deductions.

You must provide correctlydated documentary evidence toshow your income andexpenditure.

For more information on how tocomplete this section and thetypes of evidence requiredplease read the leaflet Courtfees do I have to pay them?(EX160A)

Paid/Self employment

Income from anyone living with you lodger or tenant, non-dependent children or relative

Total pensions state, private, occupational Total benefits child benefits and other benefits Money from rents, shares, bonds, or other financialarrangement

Any other income

Total gross annual income 0.00 0.00

The gross annual incomelimits can be found at page 11of the leaflet

I have read the guidance and confirm that my/our gross annual income

Exceeds the stated limits Go to section 5 Does not exceed the stated limits Go tosection 6

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5. Remission 3 full or part remission based on net monthly income and permitted expenditure

What is your net monthlyincome and expenditure?

Net monthly income Net monthly expenses

A licant Partner

Net monthly income is thetotal income you receive eachmonth after income tax, nationalinsurance and pensioncontributions have beendeducted.

The answers to these questionswill let us calculate how much ofa contribution, if any, you willneed to pay towards the courtfee.

You must provide correctlydated evidence to show yourincome and expenditure.

For more information on how tocomplete this section and thetypes of evidence requiredplease read the leaflet Courtfees do I have to pay them?(EX160A)

The fixed allowances are setamounts, see page 12 of thisleaflet.

Paid/Selfem lo ment

Housing costs Income from people living with you Fixed allowances

lodger or tenant,non-dependentchildren or relative

partner

dependant children

each child

Pension general living

expenses

state, private oroccupational

Child maintenance

Child benefit Under a court order,voluntary agreement, orChild Support Agency

Other benefits Money from rents,shares, bonds or Child care expenses other financial arran ement

Any other income Payments under a courtorder

Total net monthlyincome

0.00 0.00 Total net monthlyexpenses

0.00

6. Refund

Are you applying for arefund of a court fee paidwithin the last six months?

Yes No If Yes, what is the date you paid this fee? 7. Declaration and statement of truth

Please ensure that you providethe evidence required to supportyour application as set out in the

leaflet Court fees do I haveto pay them? (EX160A)

I believe that the facts and information stated in this application are true. I understand that if you tellanything untrue in this form, or the accompanying documents, leave anything out or fail to providesufficient evidence:

My application may be refused and the full fee will be payable

Any order or process obtained as a result of this application can be revoked

I have attached the evidence needed to support my application

Signature Date Full name

Once you have completed this form, please post it or take it, with the correct evidence, to thecourt or probate office

For the court/ robate office use onl

Name of court/ Evidence for remission 1 2 3 Risk control

Referencenumber

Court/Probate fee Signature

Form number Contribution Name

Signature Amount remitted

Name Amount to pay

Band Date

Band Date Date approved

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