Co-op Signup

In order to assess your claim please complete the form below, it should only take two minutes to complete. You will not need to provide any supporting documents at this point.

You can speak to a member of the team by calling 0203 7800 479 or emailing coopequalpay@leighday.co.uk

Personal Details

First name *

Surname *

Email address *

Email address (confirm) *

Telephone Number *

Date of Birth *

Gender *

What is your NI number?

Postcode lookup

Lookup

House Name or Number *

Address 1 *

Address 2

Address 3

Address 4

Town *

Postcode *

How did you find out about this claim?

Employment Details

Do you still work at a food store for Co-operative Group Limited? *

Yes

If not, when did you leave?

What Co-operative Group Limited food store do/did you work at (store number and name)?

Are/were you paid an hourly wage? *

Yes

Check my details