Name *

First Name

Last Name

Name *

First Name

Last Name

Phone

Country

(###)

###

####

Have you been provided with a copy of the settlement agreement? *

Yes

No

Are the terms of the settlement agreement agreed?

Yes

No

Are you prepared to sign the agreement, pending advice?

Yes

No

Don't know

Has your employer confirmed that they will pay for independent legal advice?

Yes

No

Have you been given a date by which the settlement agreement must be signed?

Yes

No