For problems using this form, please alternatively email the branch office, including all the above details/ attachments at lucu@liverpool.ac.uk

Your Full Name (required)

UCU membership number (required)

Your Email (required)

Your Telephone Number (required)

Other Telephone Number (optional)

Confirm you have already applied for the UCU national Fighting Fund, enclosing your Fighting Fund reference number (required)

Your Residential Address (required)

Explain the circumstances of your Local Fund claim (e.g. urgent caring, disability, housing, end of contract or other similar issue which would otherwise cause detriment). Here only the essential details are needed (required)

* Please attach evidence of strike periods, these can include payslip(s) demonstrating strike deductions, screenshots from CORE showing strike days or equivolent evidence. Note - you should claim for all strike days in a single Local Fund claim, regardless if your deductions are staggered. If you don't have all payslips yet (due to staggered deductions) please supply a CORE 'My Time' scan showing all days of industrial action you took or equivolent evidence (please also attach your intitial payslip or equivolent evidence showing the first staggered deduction). It would also be helpful if you can attach any document/email/invoice/bill etc. indicating the basis of your local fund claim.

File attachment 1, suggested formats are PDF, JPG, PNG (required)

File attachment 2, suggested formats are PDF, JPG, PNG (optional)

File attachment 3, suggested formats are PDF, JPG, PNG (optional)

* note the Local Fund will compensate for all days of industrial action. For the above option, please supply the TOTAL number of days you were on strike, INCLUDING the first 3 days.

Total number of strike days you declared/ were on strike (required)