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Outline

The Application for Exemption or Excusal from Jury Service form serves as a pivotal document for individuals seeking to be excused from the civic duty of jury service under specific conditions. It is imperative that applicants read both the form and the accompanying "Guide to Jury Service Eligibility and Applying for Excusal" meticulously before completing the application. The form mandates the use of a black pen and block capitals for clarity, with a straightforward method for correcting errors. Applicants are required to provide detailed personal information, ensuring the court can accurately locate their records and evaluate their request. This includes basic identification details and specifics about the court and date they have been cited to attend. The form is categorized into several sections, each designed to address different grounds for excusal, including age, residency in the UK, prior convictions, current criminal proceedings, professional obligations, and medical reasons. Importantly, there is a declaration section where the applicant must affirm the truthfulness of the information provided, underlining the seriousness of the application. The document underscores that being granted an excusal on one occasion does not exempt the individual indefinitely, as they may be called again unless granted permanent excusal. This comprehensive approach ensures that the jury service system remains just and efficient, balancing the need for a representative cross-section of society against the legitimate reasons an individual may not be able to serve.

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Application for Exemption or

Excusal from Jury Service

If you wish to apply for exemption or excusal from jury service, please read this form and the “Guide to Jury Service Eligibility and Applying for Excusal” carefully before completing it.

Please use a black pen only, and write in BLOCK CAPITALS

.

Tick boxes as appropriate. If you make a mistake/tick the wrong box, shade in the box, initial it, and mark the correct box.

On completion please return this to:

Location (from the front of your citation)

Send to

 

 

If you have been cited to the SHERIFF COURT

The court address on the front of your citation

 

 

If you have been cited to the HIGH COURT in

Justiciary Office, Parliament House, Parliament Square,

EDINBURGH

Edinburgh EH1 2NT

 

 

If you have been cited to the HIGH COURT in

The Sheriff Clerk’s Office, Glasgow Sheriff and JP Court, 1

GLASGOW

Carlton Place, Glasgow G5 9DA

 

 

If you have been cited to the HIGH COURT

The court address on the front of your citation

anywhere else

 

Part 1 – About you

Please Note: You must fill in this section carefully or the court will not be able to find your records. Your application for excusal or exemption can only be considered if this section is completed.

1. Name

 

 

 

2. Address

Date of Birth:

 

 

 

Email address:

 

 

 

 

 

 

 

3. Personal ID Number:

 

 

 

4. Citation Number:

(This can be found on the front of your citation form)

(This can be found on the front of your citation form)

 

 

 

 

 

 

 

5. Court citied to:

 

 

 

6. Date citied to attend:

(See the front of your citation)

 

 

 

 

 

 

 

High Court

 

 

Sheriff Court

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(This is on the front of your citation form)

(tick the appropriate box)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7.Please provide any daytime telephone numbers where we can contact you between 9.00am and 5.00pm. This is solely so that we can contact you quickly with any further information. It will not be used for any other purpose.

Are any of the details you have provided different to those on your jury citation? If so, please provide the details that appear on your jury citation below.

Full Name:

Please enter all your names

Address:

Postcode

email:

Part 2 – Persons not qualified or ineligible for jury service

Please read boxes A and B in the “Guide to Jury Service Eligibility and Applying for Excusal” before completing this section. If you are not qualified or are ineligible for jury service please complete boxes below as appropriate.

I am below the age of 18

I am

 

years of age and my date of birth is

 

Now go to part 4

I have not lived in the United Kingdom, the Channel Islands or Isle of Man for any period of at least 5 years, since I was 13 years old

Now go to part 4

Please read the list in box A in the “Guide to Jury Service Eligibility and Applying for Excusal” before completing this section.

I have been convicted of an offence and sentenced to one of the disposals mentioned in box A of the guide, and am not a rehabilitated person in terms of the Rehabilitation of Offenders Act 1974.

Please specify below the sentence, date of sentence and sentencing court:

and/or

I am on bail in or in connection with criminal proceedings in any part of the United Kingdom.

Please specify below the date and place (police station/court) you were granted bail:

Now go to part 4

Please read the list in box B in the “Guide to Jury Service Eligibility and Applying for Excusal” before completing this section.

I am ineligible for jury service due to my occupation.

I am employed as (please specify below)

I am receiving medical treatment for mental disorder as described in box B.

The precise category which applies to me is: ( please specify below)

Now go to part 4

Part 3 – Application for excusal from jury service

Please read the information in boxes C, D and E in the “Guide to Jury Service Eligibility and Applying for Excusal” before completing the boxes below, as appropriate, if you wish to apply for excusal.

I wish to apply for excusal from jury service:

as one of the categories in box C in the Guide to Jury Service Eligibility and Applying for Excusal applies to me.

(Please read the guidance document carefully, in the majority of cases excusal as of right would need to be requested within 7 days of receipt of the citation for jury service). The precise category which applies to me is:

I am aged 71 or over and I would like to apply for excusal as of right.

I am aged 71 or over and I would like to apply for permanent excusal

Other reason (specify below)

Other reason (where appropriate)

My date of birth is

Please note: it is an offence to falsely claim excusal as of right

as I am medically unfit for jury service and I enclose a medical certificate from my doctor.

My doctor considers my condition is long term/unlikely to change and this information is included in my medical certificate.

Now go to part 4

as I am away from home on a holiday or on business at the time I am required for jury service and I enclose evidence of this (e.g. copy of hotel confirmation, travel confirmation).

Now go to part 4

due to the following special reason:

(Please note: you must enclose any evidence supporting this reason in order that your application can be considered appropriately).

Now go to part 4

Please note: Should you be excused from jury service on this occasion, a further jury citation shall be sent to you within 12 months unless you have been permanently excused.

Part 4 – Declaration

Before completing this section, please make sure that you have read this form and the “Guide to Jury Service Eligibility and Applying for Excusal” carefully.

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

Signed

Date

FOR OFFICIAL USE ONLY

Ineligible?

 

Yes

 

 

 

Date:

 

 

 

NoExcusal:

Granted

 

Refused

 

 

 

SCS013 V3.5 February 2019

Document Attributes

Fact Number Fact Detail
1 The form is used to apply for exemption or excusal from jury service.
2 Applicants are instructed to read the "Guide to Jury Service Eligibility and Applying for Excusal" before completing the form.
3 Applicants must use a black pen and write in BLOCK CAPITALS.
4 For corrections, applicants must shade in the wrong box, initial it, and then tick the correct box.
5 Depending on where the applicant has been cited to, the completed form should be returned to specific addresses provided in the form.
6 Personal details including name, address, date of birth, email, personal ID number, and citation number must be filled out carefully.
7 The form specifies disqualifications from jury service based on age, residency, convictions, bail status, occupation, and mental disorder treatment.
8 Applications for excusal may be submitted for age, medical unfitness, being away from home, among other special reasons.
9 Applicants might be cited again within 12 months unless they have been permanently excused.
10 The declaration section of the form requires the applicant to acknowledge the accuracy of the information provided, underlining the possibility of being asked for proof.

How to Fill Out Application For Exemption Or Excusal From Jury Service

Being called for jury service is a civic duty that many may find themselves obligated to fulfill. However, circumstances arise that may necessitate an application for exemption or excusal from this duty. The process of applying for such an exemption or excusal is detailed in the Application for Exemption or Excusal from Jury Service form. Completing this form accurately is crucial for the court to consider your request. Below are the steps to fill out the form properly, ensuring your application is submitted correctly.

  1. Review Guidance: Begin by thoroughly reading the "Guide to Jury Service Eligibility and Applying for Excusal" to understand the prerequisites for exemption or excusal.
  2. Pen and Capitals: Use a black pen to fill out the form and ensure all your answers are in BLOCK CAPITALS for readability.
  3. Tick Boxes: As you progress through the form, tick boxes that apply to your situation. If a mistake occurs, shade the incorrect box completely, initial it, and then mark the correct box.
  4. Filling Out Part 1 (About You):
    • Input your full name, as requested.
    • Provide your full address including the postcode, your date of birth, and your personal email address.
    • Specify your Personal ID Number and Citation Number, both of which are found on the front of your jury citation.
    • Indicate which court has cited you (High Court or Sheriff Court) and mark your date cited to attend.
    • List any daytime telephone numbers where you can be contacted between 9:00am and 5:00pm.
    • If the details provided are different from your jury citation, supply the exact details as they appear on your citation.
  5. Completing Part 2: In this section, address your qualifications or ineligibilities for jury service based on age, residency status, criminal history, bail status, occupation, and mental health treatment, as directed in the form and the guidance document.
  6. Completing Part 3: Here, apply for the excusal from jury service by indicating your age, medical condition, professional obligations, or other relevant reasons. Remember to provide necessary evidence, such as medical certificates or proof of travel plans, as required.
  7. Declaration (Part 4): Read the declaration thoroughly, ensuring all information provided in the form is accurate to your knowledge. Date and sign the declaration to affirm the information provided.
  8. Submission: Finally, return the completed form to the appropriate address. The return address varies depending on the court you have been cited to — refer to the front of your citation for the specific return address required.

Completing and returning the Application for Exemption or Excusal from Jury Service form is a straightforward process when the steps are followed correctly. It's important to remember that accurate and honest information is vital for the court to make an informed decision regarding your excusal or exemption from jury service. Deliberate falsification of information can lead to legal consequences. If successful, keep in mind that you might be called for jury service again unless a permanent excusal is granted.

More About Application For Exemption Or Excusal From Jury Service

  1. Who is eligible to apply for exemption or excusal from jury service?

    Anyone who has received a jury citation can apply for exemption or excusal from jury service. However, certain conditions must be met, such as being under 18 years of age, not having lived in the United Kingdom, the Channel Islands, or the Isle of Man for at least 5 consecutive years since reaching the age of 13, having certain criminal convictions, being on bail, or having occupations or medical conditions that are listed as ineligible for jury service.

  2. How should I complete the Application for Exemption or Excusal from Jury Service form?

    You must fill out the form using a black pen and write in BLOCK CAPITALS. Be sure to tick the appropriate boxes for your circumstances. If a mistake is made, such as ticking the wrong box, you should shade in the incorrect box, initial it, and then mark the correct box. For your application to be considered, it's crucial that you carefully fill in the 'About you' section so the court can easily find your records.

  3. What evidence do I need to provide when applying for excusal from jury service?

    If you're applying for excusal based on medical unfitness, a holiday or business trip, or any other special reason, you must include supporting evidence such as a medical certificate from your doctor or proof of your travel plans like hotel or travel confirmations. This evidence is necessary for the court to properly consider your application for excusal.

  4. What happens if my application for excusal or exemption is accepted?

    If your application is accepted, you may be excused from jury service for this occasion. However, unless you are granted a permanent excusal, expect that a further jury citation could be sent to you within the next 12 months. This implies that being excused is typically temporary, and you might be called for jury service again in the future.

  5. Is it an offence to falsely claim excusal from jury service?

    Yes, it is considered an offence to falsely claim excusal from jury service, including falsely claiming medical unfitness. When filling out the application for excusal, you are declaring that the information provided is correct. Be aware that the court may ask you for proof to substantiate any statement you've made in your application.

Common mistakes

Filling out the Application for Exemption or Excusal from Jury Service form is a task that requires attention to detail. Unfortunately, many people make errors during this process, which can delay or complicate their request. Below are five common mistakes to avoid:

  1. Not reading the instructions carefully: The form comes with a guide titled “Guide to Jury Service Eligibility and Applying for Excusal.” Skipping this step can lead to misunderstandings about eligibility and how to properly complete the application.
  2. Using the wrong writing instrument: Instructions specify the use of a black pen only and the necessity to write in BLOCK CAPITALS. Using different colored inks or lowercase letters can cause processing delays.
  3. Improperly correcting mistakes: If a mistake is made or the wrong box is ticked, the correct method is to shade in the box, initial it, and then tick the correct box. Not following this procedure can lead to confusion regarding your selections.
  4. Incomplete personal details: The section about the applicant must be filled out carefully for the court to locate records. Any discrepancies or incomplete information can prevent your application from being considered.
  5. Failure to provide supporting evidence: Whether applying for excusal due to medical reasons, being away from home, or for a special reason, failing to enclose proof can result in the application being incomplete or denied.

To ensure a smooth application process:

  • Begin by thoroughly reviewing the guide provided with the form to understand the qualifications and requirements for exemption or excusal from jury service.
  • Use a black pen and follow the form's instructions for making corrections carefully.
  • Ensure all your personal information matches the details on your jury citation to avoid any issues with record retrieval.
  • Lastly, if requesting excusal for specific reasons such as medical unfitness or being away, remember to include all necessary documentation to support your application.

By avoiding these common mistakes, applicants can improve the likelihood that their request for exemption or excusal from jury service will be processed efficiently and without unnecessary delay.

Documents used along the form

When you're summoned for jury duty, the Application for Exemption or Excusal from Jury Service form is just the starting point for navigating the process. Completing this form might open up a need for additional documents to fully process your application. Here's a clear guide to other forms and documents that often accompany the application for exemption or excusal from jury service.

  • Medical Certificate: If you're applying for excusal based on medical grounds, a detailed certificate from your doctor or a medical professional detailing your condition is essential. This certificate should specify why your health makes you unfit for jury duty.
  • Proof of Age: For those seeking excusal based on age, a government-issued identification like a driver's license or passport that verifies your date of birth will be necessary.
  • Employment Verification: If your request for excusal is due to occupational obligations, a letter from your employer stating your role and why your absence would be detrimental can support your application.
  • Educational Commitments: Students might need to provide a current class schedule or a letter from their institution to prove that jury duty conflicts with their educational responsibilities.
  • Court Documents: Those claiming excusal for legal reasons, such as being currently on bail, need to provide relevant court documents or bail papers as evidence.
  • Travel Confirmation: If you've planned a trip and have already booked tickets or accommodations, providing copies of these confirmations is necessary to apply for an excusal due to travel.
  • Guide to Jury Service Eligibility and Applying for Excusal: While not a form to fill out, thoroughly reading this guide is crucial. It provides detailed explanations and criteria for eligibility, helping you understand the requirements and documentation needed.
  • Declaration of Hardship: If you're experiencing a financial or personal hardship that would make serving on a jury a burden, a written statement detailing your situation may be required. Evidence supporting your claim, such as financial statements or a written personal account, might also be necessary.

Gathering the right documents is a key step in applying for an excusal or exemption from jury service. Each document serves as a piece of evidence supporting your request and ensures that the process is as smooth as possible. Remember, the goal of these documents is not just to excuse you from service but to uphold the integrity of the jury selection process by ensuring those who serve are able to do so effectively and without undue hardship. Always check with your local court or its website for specific requirements and deadlines related to jury service exemption or excusal applications. Providing thorough and accurate information will help facilitate a smooth process for all parties involved.

Similar forms

  • Medical Exemption Form: Like the Application for Exemption or Excusal from Jury Service form, a Medical Exemption Form requires a doctor's certification to prove an individual's medical incapacity to perform a duty—in this case, serving on a jury. Both forms serve to exempt individuals from a legal obligation based on health concerns.

  • Student Deferral Request Form: Similar to the application for jury service excusal, this form allows students to request a postponement of obligations (like jury duty) due to academic commitments. Both documents necessitate detailed personal information and specify the reason for the requested deferral or excusal.

  • Voter Registration Eligibility Form: This form, much like the jury service exemption application, requires personal identification details and addresses criteria for eligibility. Both forms are gateways to civic duties but also contain provisions for disqualification based on certain conditions.

  • Occupational Disability Exemption Form: Similar to the part of the jury service form that addresses ineligibility due to occupation, this form exempts individuals from duties or taxes based on occupational disabilities. Detailed personal information and the nature of the occupation or disability are required on both forms.

  • Travel Plan Declaration Form: For those applying for excusal from jury service due to being away from home, this form parallels the section requiring evidence of planned travel. In both instances, individuals must provide solid proof of their claims, like hotel bookings or travel confirmations.

  • Age Declaration Form: Similar to the exemption section for individuals aged 71 or over in the jury service application, this form is used to verify an individual's age for accessing age-specific services or rights. Both rely on the honesty of applicants in declaring their age and may request proof.

  • Criminal Record Disclosure Form: This form shares similarities with the portion of the jury service application dealing with convictions and bail conditions. Both forms require individuals to disclose legal backgrounds that may disqualify them from participation in certain activities, like jury service.

Dos and Don'ts

When filling out the Application for Exemption or Excusal from Jury Service form, careful attention to detail and adherence to instructions are critical. To assist in this process, here is a list of dos and don'ts that applicants should consider:

  • Do read the "Guide to Jury Service Eligibility and Applying for Excusal" thoroughly before beginning your application. This guide contains essential information that can help clarify eligibility and the excusal process.
  • Do use a black pen and write in BLOCK CAPITALS to ensure your application is legible and can be processed efficiently.
  • Do carefully fill in the "About you" section with accurate information. This data is crucial for the court to locate your records and consider your application appropriately.
  • Do tick the correct boxes that apply to your situation. If you make a mistake, shade in the incorrect box, initial it, and then tick the correct box.
  • Do not leave any required sections incomplete. If the form asks for specific details, such as your Personal ID Number or Citation Number, be sure to provide these to avoid delays in processing your application.
  • Do not use colors other than black when filling out the form, as this may cause issues with legibility and scanning technologies.
  • Do not disregard the requirement to attach supporting evidence when applying for excusal for reasons such as medical issues, being away from home, or special circumstances. Providing comprehensive and relevant documentation is crucial for the successful consideration of your application.
  • Do not forget to sign and date the declaration part of the form. This is a critical step, as it validates the information provided in your application. Remember, it is an offense to provide false information on this form.

By following these guidelines, you can enhance the likelihood that your Application for Exemption or Excusal from Jury Service will be filled out correctly and processed without unnecessary delays.

Misconceptions

When it comes to applying for exemption or excusal from jury service, there are several misconceptions that can lead to confusion. Understanding the reality behind these misconceptions is essential for individuals looking to navigate the process effectively.

  • Only seniors and medical professionals can be excused from jury service. This is inaccurate. A wide range of circumstances may qualify an individual for excusal or exemption, including but not limited to age, medical conditions, and specific occupational responsibilities, as outlined in the application form guidelines.

  • Completing the application guarantees exemption or excusal. This is not the case. Each application is reviewed on an individual basis, and submission of the application does not automatically result in exemption or excusal. The court has the final say.

  • The process is complicated and requires legal representation. While it's important to complete the application accurately, legal representation is not necessary. The form and accompanying guide provide clear instructions for individuals to follow, emphasizing the use of black ink, BLOCK CAPITALS, and precise ticking of boxes.

  • Any mistake on the form invalidates the entire application. Errors do not necessarily void the application. The form specifically instructs applicants on how to correct mistakes: by shading in the incorrect box, initialing it, and then marking the correct one.

  • You can only be excused once, and then you're always required to serve if called again. The truth is that being excused from jury service does not prevent you from applying for excusal or exemption in the future. Each jury service citation is treated as a separate instance, allowing for multiple excusals if justified by circumstances.

  • The application process takes a long time and involves multiple steps. While it's important to provide comprehensive and accurate information, the application process itself is straightforward. It consists of filling out the form and returning it to the specified address, depending on which court cited you for jury service.

Understanding these key aspects of the application for exemption or excusal from jury service can demystify the process, providing clarity and confidence to potential jurors. It's important to refer to the guidelines provided and to communicate effectively with court officials if there are any questions or concerns.

Key takeaways

The process of applying for exemption or excusal from jury service is designed to be straightforward; however, attention to detail is crucial. To ensure your application is processed smoothly, here are key takeaways from filling out and using the Application for Exemption or Excusal from Jury Service form:

  • Read the accompanying guide carefully: Before filling out the form, thoroughly review the "Guide to Jury Service Eligibility and Applying for Excusal." It provides essential details that help determine your eligibility and guide you through the application process.
  • Use a black pen and block capitals: To avoid confusion and ensure readability, fill out the form using a black pen, and write your answers in block capitals. This makes the information easier for court staff to read and process.
  • Correcting mistakes: If you make an error, there’s a simple way to fix it. Shade in the incorrect tick box, initial your mistake, and then mark the correct box. This helps maintain the form's clarity and accuracy.
  • Know where to send the form: Depending on where you have been cited for jury service (Sheriff Court or High Court), the address to which you need to return the form varies. Make sure to send it to the correct address as listed on your jury citation to avoid any delays.
  • Complete personal details accurately: The form requires specific personal information such as your name, address, date of birth, personal ID number, and the court you’ve been cited to. Accurate completion of this section is necessary for your application to be considered.
  • Eligibility checklist: The form divides ineligibility into different categories, including age, residency, criminal convictions, bail status, occupation, and medical treatment for mental disorder. Verify your status against these criteria; they play a crucial role in determining whether you can be excused from jury service.
  • Excusal application and evidence: If applying for excusal, clearly state your reason and attach any required evidence (e.g., medical certificates, travel confirmation). This supports your application and facilitates a smoother decision-making process.
  • Understand the potential for follow-up: Submitting the form is not the end of the process. You may be asked for further proof of your statements. Additionally, being excused from jury service once does not mean you're exempt forever; you may receive another citation in the future unless you're permanently excused.

When filling out the Application for Exemption or Excusal from Jury Service, it's crucial to be thorough and honest. The form and its accompanying guide are designed to ensure that those who genuinely cannot serve on a jury, for valid reasons, are excused. Following these guidelines closely contributes to a fair and efficient jury selection process.

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