PPI Complaint Form

For more detail on how we will use your personal information, please see our Privacy Notice opens in new window.

Providing as much information as possible about the sale of your PPI will assist us in conducting a thorough investigation of your PPI complaint.

If you can't remember all the information, don’t worry, you can still complain. We might need to contact you if we have a question about the information you've given us or we need more information.

Required fields indicated with *

Section A: about you

Our Ref

If you have previously received a letter from us regarding a PPI enquiry or complaint a reference number will be quoted on the first page of our letter.

Please select the number of policies you would like to complain about Required

If you wish to complain about more than four policies please complete another questionnaire with the details.

Your name and contact details

Surname Required

Title Required

First name(s) Required

Date of birth (dd/mm/yyyy) Required

Post/zip/country code Required

Enter your post code then select 'Search' to find your address.

Address Line One Required

Address Line Two

Town Required

County

Daytime No.

Home No.

Mobile No.

Details of anyone complaining with you

Surname

Title

First name(s)

Date of birth (dd/mm/yyyy)

Post/zip/country code

Enter your post code then select 'Search' to find your address.

Address Line One

Address Line Two

Town

County

Daytime No.

Home No.

Mobile No.

In case we need to seek clarification on any concerns you have raised what would be the most convenient time to call, select all that apply

Day

Monday

Tuesday

Wednesday

Thursday

Friday

Please select which days would be convenient for us to call you, if necessary

Time

Please select the most convenient time for us to call you, if necessary

Additional comments

Previous Address - if you lived at a different address when you took out the policy please provide details

Post/zip/country code

Enter your post code then select 'Search' to find your address.

Address Line One

Address Line Two

Town

County

Accessibility

If you are experiencing difficult personal circumstances or you feel our process may need to be adapted to suit a particular need you may have, please tell us here.

Please specify