The Application for Exemption or Excusal from Jury Service form is a critical document for individuals who, for various reasons, wish to apply for exemption or excusal from serving on a jury. It is designed to guide applicants through the process, ensuring they provide all necessary information to support their request. All parts of the form, including personal details, grounds for ineligibility, and specific conditions for excusal, must be filled out meticulously and returned to the appropriate authority, depending on the court one is cited to. If you are seeking an exemption or excusal from jury service, carefully reading the guide and completing this form is the first step. For assistance in filling out the form, click the button below.
The Application for Exemption or Excusal from Jury Service form is a critical document for those seeking to be released from their civic duty of jury service under certain circumstances. This detailed form guides applicants through the process, starting with a clear instruction to use a black pen and to write in block capitals for readability. Applicants are required to tick boxes to indicate their choices, with a provision for correcting mistakes. The form demands precise information about the applicant, including personal identification number and specific court details, ensuring that the court can accurately locate the applicant's records for consideration. It meticulously outlines the eligibility criteria for application, categorizing reasons into not qualified or ineligible for service based on age, residency, criminal convictions, bail status, occupation, and mental health conditions. Furthermore, it provides a section for those applying for excusal, listing eligible categories and emphasizing the importance of submitting supporting evidence for special reasons for excusal. Importantly, the form mentions that false claims can have legal repercussions, underscoring the seriousness of the application process. Finally, it concludes with a mandatory declaration by the applicant, affirming the truthfulness of the information provided, before submission to the appropriate court address, depending on whether the individual is cited to the Sheriff Court or the High Court. The form makes it clear that being excused from jury service might only be temporary unless one qualifies for permanent excusal, indicating the possibility of being called again within 12 months.
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
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
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)
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
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:
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)
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.
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).
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).
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
Filling out the Application For Exemption Or Excusal From Jury Service form is a process that requires attention to detail. Before starting, it's important to read the provided Guide to Jury Service Eligibility and Applying for Excusal to understand the eligibility criteria and the conditions under which you can apply for exemption or excusal. Use a black pen and write in block capitals to ensure your application is legible. Correctly filling out and returning this form is crucial for your request to be considered.
After you have submitted your application, it will be reviewed by the court officials. You might be contacted for further information or clarification. It's important to provide accurate and truthful information throughout the form to avoid any legal implications. If you're granted excusal or exemption, be aware that you may receive another jury citation within 12 months unless you've been permanently excused.
To apply for exemption or excusal from jury service, you should carefully read the form and the accompanying “Guide to Jury Service Eligibility and Applying for Excusal”. Then, complete the form using a black pen and BLOCK CAPITALS. Tick the appropriate boxes and if any mistakes are made, shade the incorrect box, initial it, and then mark the correct one. Once completed, return the form to the address specified on the front of your jury citation.
If you make a mistake while filling out the form, simply shade in the incorrect box completely, initial beside it, and then tick the correct box. This ensures that your intended choice is clear.
You are required to provide detailed personal information including your name, address, date of birth, email address, personal ID number, and citation number. Additionally, you should indicate the court you are cited to, the date you're cited to attend, and provide daytime telephone numbers for contact. If any details differ from those on your jury citation, these discrepancies must be noted separately on the form.
Several criteria can render you ineligible for jury service, including being under the age of 18, not having lived in the United Kingdom, the Channel Islands, or the Isle of Man for at least 5 years since turning 13, having been convicted of certain offences, or currently being on bail. Additionally, certain occupations and undergoing treatment for mental disorders can also make you ineligible. Specifics regarding these criteria can be found in the eligibility guide that accompanies the application form.
If you are applying for excusal on medical grounds or due to other commitments (such as being away for holiday or business), you need to specify the exact reason in part 3 of the form. For medical excusals, a doctor's medical certificate stating the long-term nature of your condition must be included. For other commitments, relevant evidence (e.g., hotel bookings, travel confirmations) must be attached to your application. Make sure to refer to the guide for detailed instructions on each category for excusal.
Permanent excusal from jury service is possible under certain circumstances. If you are aged 71 or over, you can apply for permanent excusal. It's crucial to note, however, that supporting evidence or documentation is often required to successfully obtain permanent excusal. As always, refer to the accompanying guide for specific criteria and documentation requirements.
If your application for excusal is approved, you will be excused from jury service for the specific instance. It is important to understand, however, that you may receive another jury citation within 12 months unless you have been granted permanent excusal. This is in accordance with the process of ensuring that everyone eligible participates in jury service over time.
Yes, it is an offence to provide false information on the Application for Exemption or Excusal from Jury Service form. Applicants are required to declare that all information provided is correct and acknowledge that proof may be requested. Providing false information could lead to legal consequences.
Filling out the Application for Exemption or Excusal from Jury Service form is a critical process that requires attention to detail. Unfortunately, several common mistakes can compromise the application's success. By understanding and avoiding these errors, individuals can ensure their submission is processed smoothly and effectively.
Not using a black pen and writing in BLOCK CAPITALS: The form explicitly instructs applicants to use a black pen and write in BLOCK CAPITALS. This requirement ensures clarity and legibility, crucial for accurately processing the application. Failing to adhere to these instructions may result in the form being returned or the application delayed.
Incorrectly marking tick boxes: Applicants are asked to tick boxes as appropriate. A common mistake is inaccurately marking a box or changing one's mind after ticking. If an error is made, the correct protocol is to shade in the incorrect box, initial it, and then mark the correct box. Not following this procedure can lead to confusion about the applicant's intentions.
Incomplete or inaccurate Part 1 information: Part 1 of the form requires careful completion, as it contains critical personal information. The court relies on this section to locate the applicant's records. Any errors or omissions in this part can result in the application being unprocessable. This includes wrongly provided names, addresses, personal ID numbers, and citation numbers.
Skipping the eligibility guides: Before filling in parts 2 and 3, applicants must read the guides to jury service eligibility and applying for excusal provided in the document. Failing to consult these guides may lead to incorrectly claimed ineligibility or excusal categories, rendering the application invalid.
Forgetting to enclose required evidence: When applying for excusal due to specific reasons such as medical conditions, holidays, or special circumstances, it's essential to enclose relevant evidence. Failure to include this documentation can result in the application being disregarded or denied.
Avoiding these common mistakes can significantly enhance the likelihood of a successful application for exemption or excusal from jury service. It's a matter of giving the process the attention and accuracy it demands.
When applying for an exemption or excusal from jury service, there are a few additional documents and forms that one might need to consider submitting along with the Application for Exemption or Excusal from Jury Service form. Understanding these documents can help ensure your application is complete and processed smoothly.
Preparation and thoroughness are key when applying for an exemption or excusal from jury service. By accompanying your application with the appropriate forms and documents, you help the court make an informed decision regarding your request. Always ensure the information provided is current and accurately reflects your situation to avoid any delays in the processing of your application.
Medical Leave Request Form: Similar to the Application for Exemption or Excusal from Jury Service, a Medical Leave Request Form requires detailed personal information and medical certification to validate the request for leave. Both forms necessitate official documentation (medical certificate for leave, evidence of incapacity or scheduled treatment for jury excusal) to support the applicant's claim, ensuring an informed decision can be made by the reviewing authority.
Disability Benefits Application: This application often requires individuals to disclose personal information, medical conditions, and provide evidence similar to the Jury Service form, especially in parts concerning medical treatment for mental disorders. Both processes aim to evaluate the eligibility of an individual based on specific criteria, including health status.
Student Financial Aid Application: Like the jury service form, this requires detailed personal information and often necessitates documentation to support special circumstances, akin to the "special reason" section for excusal from jury duty. Both forms review the applicant's situation to determine eligibility for certain benefits (financial aid or jury excusal).
Voter Registration Form: Requires personal identification details similar to the jury service form, including name, address, and sometimes identification numbers. Both forms serve as means to participate in civic duties, albeit in different capacities.
Passport Application Form: This application shares similarities in the requirement for detailed personal information, citation numbers (akin to passport numbers), and a declaration of accuracy at the end. Both documents necessitate accuracy and honesty, with legal implications for false information.
Change of Address Form (Postal Service): It requires individuals to provide current and new addresses, similar to updating contact information in the jury service form if it differs from the citation. Both ensure that important communication reaches the individual.
Employment Eligibility Verification Form (I-9): Similar to parts of the jury service form that determine eligibility based on personal circumstances (such as residence history or criminal background), the I-9 form requires detailed personal information and documentation to establish eligibility for employment.
Gun Permit Application: Like the jury excusal form, applicants must provide personal information, possibly answer questions regarding criminal history, and make a declaration of truth. Both forms involve legal responsibilities and require the assessment of eligibility based on set criteria.
Filling out the Application For Exemption Or Excusal From Jury Service form must be approached with due diligence and accuracy. In order to ensure that your application is correctly processed, here are several dos and don'ts to keep in mind:
There are several misconceptions surrounding the Application for Exemption or Excusal from Jury Service form. Understanding these can help clarify the process and requirements for applying for exemption or excusal from jury service.
It’s important for individuals cited for jury service to thoroughly read the form and accompanying guide to better understand the process and meet the requirements for applying for excusal or exemption. This ensures that the application is correctly filled out and improves the chances that their application will be considered appropriately.
Filling out the Application for Exemption or Excusal from Jury Service requires your attention to detail and understanding of the criteria. Here are key takeaways to guide you through the process:
Understanding these key points can streamline the process of applying for exemption or excusal from jury service, making it a more straightforward task.
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