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Mr Douglas Iain Gardiner
1 Place St Jean Lot 10
Chateau-Gontier
53200
France
Compensation is sought for personal injury and the losses of current and future earnings, arising from an
industrial accident 09/12/10 at the former premises of Exsto UK Ltd 67 Roundponds, Melksham.
The nature of the personal injury sustained & confirmed by the DWP as; “Impaired mental equilibrium”
The nature of the illness confirmed by the DWP as; “Significant, disability depression & anxiety”
The claimant expects to recover as general damages for pain, suffering and loss of amenity no more than
£25,000. Loss and future loss of earnings no more than £600,000 before tax. The claimant claims interest
under section 69 of the County Courts Act 1984 at the rate of 8% per annum and continuing at the same
rate up to the date of judgment or earlier payment.
Chippenham
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Defendant 1) Exsto UK Ltd, Kingsbury House, Kingsbury Square, Melksham, SN12 6HL
Defendant 2) Exsto ZI, 55 av. de la Déportation, BP 280 - 26100 Romans Cedex France
Defendant 3) Peninsula Business Services,The Peninsula 2 Cheetham Hill Rd,Manchester,Lancashire M4 4FB,
ͬ¿¬»³»²¬ ±º Ì®«¬¸
öø× ¾»´·»ª»÷ø̸» Ý´¿·³¿²¬ ¾»´·»ª»-÷ ¬¸¿¬ ¬¸» º¿½¬- -¬¿¬»¼ ·² ¬¸»-» °¿®¬·½«´¿®- ±º ½´¿·³ ¿®» ¬®«»ò
ö × ¿³ ¼«´§ ¿«¬¸±®·-»¼ ¾§ ¬¸» ½´¿·³¿²¬ ¬± -·¹² ¬¸·- -¬¿¬»³»²¬
-·¹²»¼
öøÝ´¿·³¿²¬÷øÔ·¬·¹¿¬·±² º®·»²¼÷øÝ´¿·³¿²¬Ž- -±´·½·¬±®÷
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1) DWP facts of accident
2) Facts found at Bristol Employment Tribunal
3) Loss of quality of life
4) Compensation
5) Wasted costs
6) Res Judica & estopple do not apply
7) Statement of inability to pay costs
8) Pre Action protocol
9) Letter Lord Freud
10) Statement of truth
ÜÑËÙÔßÍ ×ß×Ò ÙßÎÜ×ÒÛÎ
D09L45@GMAIL.COM
---------------------------------
-----------------------------------------------------------------------------------------
------------------------------------------------------- ----------------------------------------------------------

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CPR Part 7 Claim Form for Personal Injury and Loss of Earnings

  • 1. Òï Ý´¿·³ º±®³ øÝÐΠﮬ é÷ øïîòïî÷ w Ý®±©² ݱ°§®·¹¸¬ îðïî ɸ»² ½±®®»-°±²¼·²¹ ©·¬¸ ¬¸» ½±«®¬ô °´»¿-» ¿¼¼®»-- º±®³- ±® ´»¬¬»®- ¬± ¬¸» ݱ«®¬ Ó¿²¿¹»® ¿²¼ ¯«±¬» ¬¸» ½´¿·³ ²«³¾»®ò Ý´¿·³ Ú±®³ ß³±«²¬ ½´¿·³»¼ ݱ«®¬ º»» ͱ´·½·¬±®Ž- ½±-¬- ̱¬¿´ ¿³±«²¬ } Þ®·»º ¼»¬¿·´- ±º ½´¿·³ Ü»º»²¼¿²¬Ž- ²¿³» ¿²¼ ¿¼¼®»-- º±® -»®ª·½» ·²½´«¼·²¹ °±-¬½±¼» Ê¿´«» Ý´¿·³¿²¬ø-÷ ²¿³»ø-÷ ¿²¼ ¿¼¼®»--ø»-÷ ·²½´«¼·²¹ °±-¬½±¼» ÍÛßÔ ×² ¬¸» Ü»º»²¼¿²¬ø-÷ ²¿³» ¿²¼ ¿¼¼®»--ø»-÷ ·²½´«¼·²¹ °±-¬½±¼» º±® ½±«®¬ «-» ±²´§ Ý´¿·³ Ò±ò ×--«» ¼¿¬» DZ« ³«-¬ ·²¼·½¿¬» §±«® °®»º»®®»¼ ½±«®¬ º±® ¸»¿®·²¹- ¸»®» ø-»» ²±¬»- º±® ¹«·¼¿²½»÷ Mr Douglas Iain Gardiner 1 Place St Jean Lot 10 Chateau-Gontier 53200 France Compensation is sought for personal injury and the losses of current and future earnings, arising from an industrial accident 09/12/10 at the former premises of Exsto UK Ltd 67 Roundponds, Melksham. The nature of the personal injury sustained & confirmed by the DWP as; “Impaired mental equilibrium” The nature of the illness confirmed by the DWP as; “Significant, disability depression & anxiety” The claimant expects to recover as general damages for pain, suffering and loss of amenity no more than £25,000. Loss and future loss of earnings no more than £600,000 before tax. The claimant claims interest under section 69 of the County Courts Act 1984 at the rate of 8% per annum and continuing at the same rate up to the date of judgment or earlier payment. Chippenham Ò± ³±®» ¬¸¿² êîëôððð ïôêéð ð êîêôêéð - - -- Defendant 1) Exsto UK Ltd, Kingsbury House, Kingsbury Square, Melksham, SN12 6HL Defendant 2) Exsto ZI, 55 av. de la Déportation, BP 280 - 26100 Romans Cedex France Defendant 3) Peninsula Business Services,The Peninsula 2 Cheetham Hill Rd,Manchester,Lancashire M4 4FB,
  • 2. ͬ¿¬»³»²¬ ±º Ì®«¬¸ öø× ¾»´·»ª»÷ø̸» Ý´¿·³¿²¬ ¾»´·»ª»-÷ ¬¸¿¬ ¬¸» º¿½¬- -¬¿¬»¼ ·² ¬¸»-» °¿®¬·½«´¿®- ±º ½´¿·³ ¿®» ¬®«»ò ö × ¿³ ¼«´§ ¿«¬¸±®·-»¼ ¾§ ¬¸» ½´¿·³¿²¬ ¬± -·¹² ¬¸·- -¬¿¬»³»²¬ -·¹²»¼ öøÝ´¿·³¿²¬÷øÔ·¬·¹¿¬·±² º®·»²¼÷øÝ´¿·³¿²¬Ž- -±´·½·¬±®÷ ö¼»´»¬» ¿- ¿°°®±°®·¿¬» Ý´¿·³ Ò±ò ﮬ·½«´¿®- ±º Ý´¿·³ ø¿¬¬¿½¸»¼÷ø¬± º±´´±©÷ Ú«´´ ²¿³» ܱ»-ô ±® ©·´´ô §±«® ½´¿·³ ·²½´«¼» ¿²§ ·--«»- «²¼»® ¬¸» Ø«³¿² η¹¸¬- ß½¬ ïççèá Ç»- Ò±ì 1) DWP facts of accident 2) Facts found at Bristol Employment Tribunal 3) Loss of quality of life 4) Compensation 5) Wasted costs 6) Res Judica & estopple do not apply 7) Statement of inability to pay costs 8) Pre Action protocol 9) Letter Lord Freud 10) Statement of truth ÜÑËÙÔßÍ ×ß×Ò ÙßÎÜ×ÒÛÎ D09L45@GMAIL.COM --------------------------------- ----------------------------------------------------------------------------------------- ------------------------------------------------------- ----------------------------------------------------------