Application For Exemption Or Excusal From Jury Service Form PDF Details

Are you currently registered as a voter in your county? If so, you may be randomly selected to serve on a jury. Serving on a jury is both a civic duty and an important responsibility that helps our justice system function. If you are unable to serve for any reason, you may apply for exemption or excuse from Jury Service using the form below. Complete the form and submit it to your county clerk's office. If you have any questions about Jury Service or this application, please contact your county clerk's office. Thank you for your service!

QuestionAnswer
Form NameApplication For Exemption Or Excusal From Jury Service Form
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesedinburghhcjurors scotcourts gov uk, jury excusal scotland, edinburgh hc jurors scotcourts gov uk, excusal from jury service scotland

Form Preview Example

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

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Stage # 1 of submitting glasgow jurors scotcourts gov uk

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Guidelines on how to fill in glasgow jurors scotcourts gov uk step 2

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