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Online Viability Questionnaire

This form may be used to provide Nestor Partnership with details of any personal injury cases where damages are potentially due to be awarded. The information provided will be treated in strictest confidence and in accordance with our Data Protection Policy.

Should you wish to discuss your individual circumstances with one of the Partners in more detail, please call us on 0161 763 4800.

Alternatively, please click here to download this questionnaire on PDF format.

Name of Firm:
Contact Name:
Telephone:
Email:
CICA Case:
Anticipated Level of
Damages:
Patient or Minor:
Interim Payments:
If so, date first
payment received:
When do you anticipate
payment?:
Do you wish for Nestor
Partnership to advise
the claimant direct?:
Claimant Details
Name:
Date of Birth:
Telephone:
Address:
Postcode:

What Means Tested Benefits are you and/or your spouse/partner currently receiving? Please not that all amounts should be entered on a 'per week' basis

Income Support:
Health Benefits:
Pension Credit:
Housing Benefit:
Child Tax:
Council Tax:
Working Tax Credit:
Income-based
Jobseeker's Allowance:
Are you receiving any
other social security
benefits?
If yes, please detail:
Please give details of your own and if applicable your partner's / spouse's savings including cash you have at home, premium bonds, stocks and shares, unit trusts, and money in a bank account of building society:
Please tell us briefly what your immediate spending plans are once you are in receipt of your award:
Captcha:
 

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Nestor Partnership LLP
Controlled House
Waterfold Business Park
Rochdale Road
Bury BL9 7BR
DX 20511 Bury

t. 0161 763 4800
f. 0161 763 4809

e. info@nestorpartnership.co.uk

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