PPI Claims Form

Please complete the form below to begin your PPI Claim free assessment.

Title: *

First Name: *

Surname: *

Date of Birth (dd/mm/yyyy): *

Was The Loan Taken Out In Sole Or Joint Names: *

First Name Of Joint Applicant (if applicable):

Surname Of Joint Applicant (if applicable):

Date Of Birth Of Joint Applicant (if applicable):

House Number/Name: *

Street Name: *

Town: *

County: *

Postal Code: *

Telephone Number:

Mobile Number:

Email Address: *

Name Of The Company Who Sold You the Loan: *

Date The Loan Was Taken Out (dd/mm/yyyy): *

How Much Was The Loan For £: *

Loan Account Number (if known):

Q1 I was not aware at the time of the sale that I had been sold PPI: *

Q2 The Advisor Insisted I Took Out The PPI With The Loan: *

Q3 I was lead to believe that my chances of getting the loan were increased if I took out the PPI : *

Q4 I was not told I did not have to take out PPI with the loan: *

Q5 I was not told I could purchase PPI elsewhere: *

Q6 The cost of the PPI was not explained seperatly from the cost of the PPI: *

Q7 I was not asked if I had any other forms of insurance cover: *

Q8 I was not told that I may not be able to claim under certain exclusions contained in the policy: *

Q9 Exclusions in the policy were not pointed out to me: *

Q10 The importance of reading the PPI documentation was not pointed out to me: *

Q11 The PPI was an upfornt premium added to the loan: *

Q12 The loan was paid off early and I received no refund of PPI premiums: *

Q13 I increased my loan and the PPI was increased automaticaly: *

Q14 When I took out the loan/ppi I was employed/Self Employed/Unemployed: *

Please Add Any Notes You Think May Assist With your Claim: