SCHEDULE OF LOSS TEMPLATE
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A. PAST LOSS
Net weekly pay at dismissal: £____
Period from EDT to hearing: ____ weeks
Loss of earnings: £____ (A1)
Less: earnings from new work £____; benefits received £____
Pension loss (employer contributions × weeks): £____
Expenses (travel to interviews etc.): £____

B. FUTURE LOSS
Estimated weeks to equivalent role: ____ × net weekly pay = £____
Ongoing pension loss: £____

C. UNFAIR DISMISSAL AWARDS
Basic award (age/service/weekly pay formula, statutory cap): £____
Compensatory award (A + B, capped at 52 weeks' pay / statutory max): £____
ACAS Code adjustment (+/- up to 25%): £____

D. DISCRIMINATION (if claimed — uncapped)
Injury to feelings (Vento bands — lower/middle/upper; state band and why): £____
Interest (8% p.a.): £____
Aggravated damages (only for high-handed conduct — explain): £____

E. MITIGATION SUMMARY
Jobs applied for: ____ (attach log with dates)
Agencies registered: ____
Training undertaken: ____

TOTAL CLAIMED: £____

Prepared by: [name]   Date: [date]

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Template from YourWorkRights.uk — free, independent guidance.
This template is general guidance, not legal advice. Adapt it to
your facts. For advice on your case: ACAS 0300 123 1100.
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