our ref:

payment protection insurance: consumer questionnaire

WHAT IS THIS QUESTIONNAIRE FOR? This questionnaire is or consumers to !rin" a comp#aint a!out the sa#e o payment protection insurance $%%I&' It is the stan(ar( %%I questionnaire use( !y most inancia# !usinesses as )e## as !y the Financia# Om!u(sman Ser*ice' The questionnaire as+s you or the persona# an( inancia# (etai#s nee(e( to sort out your comp#aint' WHAT ,O I NEE, TO ,O? %#ease i## in this questionnaire- "i*in" as much in ormation as you can' It may ta+e you some time to "o throu"h the questionnaire an( "et a## your acts to"ether' .ut ha*in" a## the in ormation in one p#ace shou#( mean your case can then !e assesse( more quic+#y'

For more in ormation on !rin"in" a %%I comp#aintphone the Financia# Om!u(sman Ser*ice on /0// 120 3222 or /4// 121 3222'

section A: about you

A'1 your name an( contact (etai#s
your details surname first name(s) date of birth
d

details of anyone complaining with you title title

address for writing to you (including your postcode)

daytime phone home phone

mobile email

A'2 i someone is comp#ainin" on your !eha# $eg a re#ati*e or c#aims mana"er& p#ease "i*e us their (etai#s
their name relationship to you

address for writing to them (including postcode) their daytime phone their email

their fax their ref

A'0 )hat5s the name o the inancia# !usiness you5re comp#ainin" a!out? A'6 )hat5s the po#icy num!er o the payment protection insurance you5re comp#ainin" a!out?

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section B: about the sale of the insurance

.'1 )hen (i( you ta+e out this payment protection insurance?

cant remember

.'2 (i( the payment protection insurance pro*i(e single co*er $to co*er 7ust you& or joint co*er $to co*er you an( your partner&?
single &oint

.'0 ho) )as this insurance so#( to you? You might ha e been sold the insurance at a different time to when you too! out your loan or credit"
during a meeting during a phone con ersation you were gi en a leaflet to fill in o er the internet by post cant remember

.'6 (i( the inancia# !usiness "i*e you a(*ice or recommen( that you ta+e out this insurance?
yes no cant remember

.'8

ho) (i( you pay or this insurance?

with a single payment (#premium$) paid up%front as a one%off with a #premium$ paid each month not sure

.'3

)hat5s the current situation )ith this insurance?

d d

the insurance is still running

the insurance ended when the loan was paid off (or when the credit card account was closed) the insurance was cancelled (if so' when did this happen() payment protection insurance: consumer questionnaire
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section 9: a!out the money you !orro)e(

.': ha*e you e*er ma(e a c#aim on the payment protection insurance you5re comp#ainin" a!out?

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section 9: a!out the money you !orro)e(

yes -

no

- .f #yes$' tell us below why you claimed on the policy (for example' you were made unemployed) and the date of your claim" Also tell us if the insurer turned down your claim" /lease enclose copies of any paperwor! you recei ed from the insurer about this claim"

section ): about the money you borrowed

9'1 )hat (i( you !uy the payment protection insurance to co*er?
a personal loan a business loan a credit card a mortgage an o erdraft a store card a loan secured on your home in addition to your mortgage catalogue shopping hire purchase not sure what was the account number(

*his account number will be different to the insurance policy number on page 1 (at +uestion A",)"

9'2 )hat )as your reason or !orro)in" the money $or ta+in" out the cre(it&?

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section 9: a!out the money you !orro)e(

refinancing or consolidating other debts (if so' please complete +uestion )"3 on the next page) buying a car paying for home impro ements paying for a wedding paying for a holiday non%essential spending (for example' buying a new *3) essential e eryday spending (for example' rent' household bills or food shopping) business loan other (please tell us more below)

9'0 i you !orro)e( the money to pay o other debts- p#ease te## us more a!out those (e!ts?
what were the names of the companies you had those other debts with( were they credit cards or loans( how much did you owe( 0 when did you ta!e them out( when did you pay them off(

9'6 ha*e you e*er misse( payments ; or "one into arrears ; on the #oan or cre(it you #iste( in question 9'1? yes no

- .f #yes$' please tell us more below" 1or example 2 how many times ha e you missed payments and by how much 2 and whats your current situation(

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section 9: a!out the money you !orro)e(

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section 4: about your personal circumstances

,'1 at the time you too+ out the payment protection insurance- )hat )as your emp#oyment status $an( your partner5s ; i re#e*ant&?
you employed self employed temporary 5 agency wor!er not wor!ing retired director of own company student in full%time or part%time education wor!ing fewer than 16 hours not !nown other .f you were a student 2 but also had a &ob 2 how many hours were you wor!ing each wee!( your partner employed self employed temporary 5 agency wor!er not wor!ing retired director of own company student in full%time or part%time education wor!ing fewer than 16 hours not !nown

other
.f your partner was a student 2 but also had a &ob 2 how many hours were they wor!ing each wee!(

,'2 i your emp#oyment status has chan"e( since you too+ out the insurance- te## us ho)'
1or example 2 if you were self%employed' but are now employed"

,'0 )hat type o )or+ (i( you (o )hen you too+ out the payment protection insurance ; an( )hat )as the name o your emp#oyer?
you type of wor! your partner

name of your employer(s)

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section E: a!out your comp#aint

,'6 ho) #on" ha( you !een )or+in" there- )hen you too+ out the payment protection insurance?
you your partner years

months

years

months

,'8 i you )ere emp#oye( )hen you too+ out the insurance- )ou#( you ha*e recei*e( any pay rom your emp#oyer ; i you )ere o )or+ (ue to sic+ness or an acci(ent ; or i you )ere ma(e re(un(ant?
you yes no cant remember not rele ant (as you werent employed) your partner yes no cant remember not rele ant (as they werent employed)

- .f #yes$' what pay would you ha e recei ed from your employer( less than 3 months 3 months or more' but less than 6 months 6 months or more' but less than 17 months 17 months or more no pay (or statutory pay) other (please tell us more below)

,'3 i you ha(n5t !een a!#e to )or+ $!ecause you )ere i##- in an acci(ent or ha( !een ma(e re(un(ant&- )ou#( you ha*e ha( any other )ay o ma+in" your repayments?
1or example 2 from sa ings or other insurance policies"

you yes no

your partner yes no

- .f #yes$' how would you ha e made your repayments 2 if you hadnt been able to wor!( from sa ings or insurance 2 worth less than 3 months of your pay from sa ings or insurance 2 worth 3 months or more' but less than 6 months of your pay from sa ings or insurance 2 worth 6 months or more' but less than 17 months of your pay from sa ings or insurance 2 worth 17 months or more of your pay none by some other means (please tell us more below)

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section E: a!out your comp#aint

,': )hen you too+ out this insurance- (i( you or your partner ha*e any hea#th pro!#ems ; or )ere either o you re"istere( as (isa!#e(?
you yes no your partner yes no

- .f #yes$' ha e you e er been off wor! because of this condition 2 and if so' for how long(

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section E: a!out your comp#aint

section 8: about your complaint

this pa"e is or you to te## us )hat happene( ; )hen you too+ out the payment protection insurance
1or example' please tell us any details you remember about: 9here the sale too! place 2 and who you spo!e to at the financial business" *he information you were gi en before you too! out the insurance" :ow the cost' benefits and terms of the insurance were explained to you" *he +uestions you as!ed before ta!ing out the insurance" 9hy you decided to ta!e out the insurance"

.f you need more space' please use the spare page at the end of this +uestionnaire"
/lease send us copies of any documents you ha e from when you too! out the payment protection insurance"

ina##y- te## us )hy you are no) unhappy )ith the insurance

.f you need more space' please use the spare page at the end of this +uestionnaire"

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section E: a!out your comp#aint

section 1: your declaration

. confirm . want to ma!e a formal complaint about the sale of the payment protection insurance described in this +uestionnaire" . confirm that all the information . ha e gi en in this +uestionnaire is true and accurate to the best of my !nowledge"

d

your name

your si"nature

your name

your si"nature

You (and your partner' if its a &oint complaint) need to sign here 2 e en if someone else is bringing the complaint on your behalf" .f someone is complaining for you (eg a relati e or claims manager)' your signature here means you authorise the person named on page 1 to represent you in this complaint"

p#ease tic+ to con irm you ha*e = included e erything you want to tell us about your complaint signed the declaration abo e enclosed copies of all rele ant documents or not enclosed any documents with this form

; 1inancial <mbudsman =er ice' >une 7?17" *he 1inancial <mbudsman =er ice owns the copyright of this +uestionnaire" *he +uestionnaire can be freely copied by third

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section E: a!out your comp#aint parties in ol ed in bringing or settling financial complaints 2 as long as no changes are made to the text or graphic design' and pro ided that clear reference is made to the 1inancial <mbudsman =er ices ownership of the copyright"

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p#ease use this pa"e i you nee( more space

+uestion number your answer