In the Supreme Court of the United Kingdom

This notice of appeal is filed on behalf of……………………...................................

On appeal from Court……………………. Decision being appealed dated………………………………… Permission to appeal granted on……………………………… Judges……………………………. In that court the proceedings were between (Appellant/Respondent in the Supreme Court)

——V—— (Appellant/Respondent in the Supreme Court)

This form was filed on / /

D D M M M Y Y Y Y

Appellant’s solicitors in the Supreme Court

Respondent’s solicitors in the Supreme Court

Case Number

Appeal Form

Appellant’s full name

Original status

Name

Address

Postcode

Email

How would you prefer us to communicate with you?

Is the appellant in receipt of public funding/legal aid?

Name

Address

Postcode

Email

Page 2 Form 1 Notice of appeal

Appellant

Claimant/Pursuer Defendant/Defender Petitioner Respondent

Solicitor

Telephone no.

Fax no.

DX no.

Ref.

DX Email

Post Other (please specify)

Yes No If Yes, please give the certificate number

Counsel

Telephone no.

Fax no.

DX no.

Name

Address

Postcode

Email

Respondent’s full name

Original status

Name

Address

Postcode

Email

How would you prefer us to communicate with you?

Is the respondent in receipt of public funding/legal aid?

Page 3 Form 1 Notice of appeal

Counsel

Telephone no.

Fax no.

DX no.

Respondent

Claimant/ Pursuer Defendant/ Defender

Petitioner Respondent

Solicitor

Telephone no.

Fax no.

DX no.

Ref.

DX Email

Post Other (please specify)

Yes No If Yes, please give the certificate number

Name

Address

Postcode

Email

Name

Address

Postcode

Email

Name of Court

Names of Judges

Date of order/ interlocutor/decision

Page 4 Form 1 Notice of appeal

Counsel

Telephone no.

Fax no.

DX no.

Counsel

Telephone no.

Fax no.

DX no.

Decision being appealed

/ /

D D M M M Y Y Y Y

Name of Court granting

permission

Date permission granted

Conditions on which permission granted

Page 5

Form 1 Notice of appeal

Permission to appeal

Set out details about the grant of permission to appeal

/ /

D D M M M Y Y Y Y

Are you applying for an extension of time?

Page 6

Form 1 Notice of appeal

Information about the decision being appealed This should include the following on separate sheets

• Narrative of the facts

• Statutory framework

• Chronology of proceedings

• Relevant orders made in the Courts below

• Issues before the Court appealed from

• Treatment of issues by the Court appealed from

• Issues in the appeal • Ground of appeal (to include counsel’s name or signature.)

Other information about the appeal

Yes No

If Yes, please explain why

Page 7

Form 1 Notice of appeal

What order are you asking the Supreme Court to make?

set aside vary

set aside restore vary

Yes No

Are you seeking a declaration of incompatibility?

Yes No

Are you challenging an act of a public authority?

Yes No

If you have answered Yes to any of the questions above please give details below:

Yes No

If Yes, please give details below:

Court’s devolution jurisdiction?

Original order

Order being appealed

Does the appeal raise issues under the:

Human Rights Act 1998?

Are you asking the Supreme Court to:

depart from one of its own decisions or from one made

by the House of Lords?

make a reference to the Court of Justice of the

European Union?

Will you or the

respondent request an expedited hearing?

Page 8

Form 1 Notice of appeal

Yes No

If Yes, please give details below:

Yes No

If Yes, please give details below:

Yes No

If Yes, please give details below:

The date on which this form was served on the

Neutral citation of the judgment appealed against e.g. [2009] EWCA Civ 95

References to Law Report in which any relevant judgment is

reported.

Subject matter catchwords for indexing.

Page 9

Form 1 Notice of appeal

Certificate of Service Either complete this section or attach a separate certificate 1st Respondent / / D D M M M Y Y Y Y 2nd Respondent / / D D M M M Y Y Y Y

I certify that this document was served on

by

by the following method

Signature

9. Other relevant information

/ /

/ /

/ /

/ /

Please return your completed form to: The Supreme Court of the United Kingdom, Parliament Square, London SW1P 3BD DX 157230 Parliament Square 4 Telephone: 020 7960 1991/1992 Fax: 020 7960 1901 email: registry@supremecourt.uk www.supremecourt.uk