MP FINANCIAL - PPI (PAYMENT PROTECTION INSURANCE) COMPLAINT QUESTIONNAIRE. SECTION 1 - About You

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1 MP FINANCIAL - PPI (PAYMENT PROTECTION INSURANCE) COMPLAINT QUESTIONNAIRE SECTION 1 - About You Section 1 (A) - Personal Details Surname Title Surname Title First Name (s) First Name (s) Date Of Birth Day Month Year Date Of Birth Day Month Year Address (This is the address to which correspondence should be sent) - Please include Postcode Home Number Mobile Section 1(B) - Your Claims Advisor MP Financial, 20 The Square Carshalton Village, Surrey, SM5 3BN F (0208) Ministry of Justice Claims Regulation Number - CRM28638 Mark Pain, ACMS, MSCI, BA (Hons) Section 1(C) - What is the name of the Financial Services company you are claiming about? Section 1(D) - What is the policy number of the PPI you are complaining about? SECTION 2 - About the Insurance Section 2 (A) - To the best of your knowledge, when did you tale out this insurance? CAN'T REMEMBER Day Month Year Section 2 (B) - Was the PPI for Joint or Single Cover? SINGLE JOINT Section 2 (C) - How was the insurance sold to you? In a Meeting Over the phone By Post Over the Internet Filling in a Form/Leaflet Unsure Section 2 (D) - Were you offered advice or recommended to tale out an insurance policy? Yes No Unsure Section 2 (E) - How was the insurance paid for? Up-Front Installments Unsure Section 2 (F) - What is the current status of this insurance? Still Running? Cancelled The Credit Agreement in question was paid off Section 2 (G) - Have you ever made a claim on the insurance you are claiming about? Yes No If Yes, please give details, including any information on the compensation you received.

2 SECTION 3 - About the sale of the Insurance & the money you borrowed Section 3 (A) - What was the payment protection insurance sold to you intended to cover? Personal Loan Catalogue Shopping Mortgage Overdraft Hire Purchase Unsure Business Loan Store Card Credit Card What was the Account Number Section 3 (B) - What was the purpose of the borrowing (Why did you seek credit?) Section 3 (C) - Have you ever had financial difficulty with this borrowing, i.e. missed payments or arrears? Yes No DMP IVA Bankruptcy Other If Yes, please give details. SECTION 4 - About your personal circumstances Section 4 (A) - What was your employment status at the time you took out this insurance? Working Company Director Working Company Director Self-Employed Part Time <16 Hours p/w Self-Employed Part Time <16 Hours p/w Not Working / Unpaid Work Retired Not Working / Unpaid Work Retired Agency/Temporary Worker Student Agency/Temporary Worker Student Section 4 (B) - How has your employment status changed since the time you took out this insurance? For example, have you moved jobs, become self employed or retired etc Section 4 (C) - What was your employment at the time you took out the insurance, and by whom were you employed? Your Job Details Your Partner's Job Details Job Title Job Title Name Of Employer Name Of Employer Length of Service (At the time Insurance was sold) Length of Service (At the time Insurance was sold) Section 4 (D) - Were you entitled to Sickness, accident or redundancy benefits in connection to your employment at the time you were sold the insurance? Yes No Yes No Can't Remember Not Applicable Can't Remember Not Applicable (Not employed) (Not employed) Please detail below the type of employee benefits you are/were entitled to from your employer.

3 Section 4 (E) -Did you have alternative means of repaying the credit agreement subject to the insurance? (This may include access to savings, assistance from relatives or friends, or other insurance policies that would provide benefit) Yes No Yes No If you have answered 'Yes' please give details: Section 4 (F) - Are you aware of any health problems you may have had at the time the insurance was sold? Yes No Yes No If you have answered 'Yes' please give details: SECTION 5 - About your complaint Your are making a complaint against the financial institution which sold you a financial product, please use this section to elaborate on any important details regarding your complaint. Where did the sale take place? Can't Remember Can't Remember Who spoke to you? Can't Remember What Information were you give before you took out the insurance? Can't Remember How were the costs & benefits explained to you? Can't Remember What questions were you asked before taking out the insurance? Can't Remember What changes to your health have occurred since you took out the insurance? Not Applicable Why are you now unsatisfied with this insurance?

4 SECTION 6 - Signed Declaration By signing this declaration I confirm I wish to pursue a formal complaint about the sale of PPI as detailed in the statements above. The information provided is to the best of my knowledge a true and accurate representation of the facts related to my complaint. Signature Print Name Date I have taken advice from MP Financial, who are authorised by the Ministry of Justice, CRM28638

5 CLIENT CONTRACT PPI Compensation Claim MP Financial Definitions: Terms of Engagement for appointment of MP Financial as Claim(s) adviser. Claim(s)" means the Client's claim(s) against the Company(s) relating to the mis- selling of payment protection insurance policy(s) (PPI) "Client" means the policyholder/account holder(s), whose details are set out in the Letter of Authority and who have appointed MP Financial "Company" means the Insurance Company, Bank, Building Society, Credit Card Company or Financial Advisor or any other entity that sold the policy to the Client. "Compensation" means total of any sums offered by the Company as a result of a Claim, including but not limited to gestures of goodwill, interest, reductions in borrowing and or arrears, and repayment of premiums; "Fee" means the fee of 15% which is applicable to the gross compensation paid to the Client by the Company Engagement: By signing and returning the Letter of Authority, the Client agrees to be bound by the Terms and appoints MP Financial pursue the Claim. The Client will: By completing and signing the Letter of Authority give MP Financial consent and full authority to deal with the Company on the Client's behalf. Deal promptly with every reasonable request by MP Financial for information and documents that MP Financial may from time to time require. Inform MP Financial of any relevant matters affecting the Claim or when payment has been received. Upon payment of a compensation figure to the Client, MP Financial will invoice the Client for the Fee, which will become immediately due and payable within 30 days. Give MP Financial the right to deal exclusively with the Claim. MP Financial will: Rely on the information and documents provided by the Client as true, accurate, and complete. Use reasonable efforts to obtain maximum Compensation for the Client. Promptly notify the Client if the Claim is not to be pursued. Promptly notify the Client of the outcome of the Claim. Preserve confidentiality, including the Client's personal information except where required by law. Ministry of Justice CRM

6 Acting In The Client s best interests MP Financial will conduct a full appraisal of the Client s financial circumstances, detailing all indebtedness, an appraisal of their monthly budgets whilst accounting for any legal processes, be these concluded or underway. Where a Bankruptcy or Individual Voluntary Arrangement (IVA) has occurred or may occur, MP Financial will ensure any advice given will not prejudice either the bankruptcy or IVA. MP Financial will only proceed with a Claim where it is reasonable to expect the Client s financial position will be improved through the receipt of Compensation. Payment of Fees Creditors have the right to set off Compensation against loan arrears. Where this is the case the Client will have a liability to MP Financial, without any direct cash Compensation to repay the Fee. Where any Fee exceeds 250, the Client may pay this Fee in 6 equal monthly installments. Where the Fee exceeds 500 the Client may pay this in 12 equal monthly installments. No interest will be charged on any Fee. Example Fees: Example A Cash Example B Cash & Loan Reduction Example C Cash & Offset in Arrears Compensation 3,000 Compensation 3,000 Compensation 3,000 Cash 3,000 Cash 1,000 Cash 0 Loan Reduction 2,000 Fees (15%) 450 Fees (15%) 450 Fees (15%) 450 VAT (20%) 90 VAT (20%) 90 VAT (20%) 90 Total Fee 540 Total Fee 540 Total Fee 540 Client Receives 2,460 Client Receives 460 Client Pays 540 No Loan reduction as loan has already been paid in full The Process Customer benefits from lower loan installments and reduced loan balance of 2,000 Customer benefits from lower loan installments and reduced loan balance of 3, MP Financial will request the client to sign authority documents giving us the ability to request from your Creditors details about your credit agreements. 2. We will write to your creditors asking for the Key Features of the Client s credit agreements, particularly any details of Payment Protection Insurance charged to the product, be this up-front or on an on-going basis. 3. We will ask the Creditor to provide the contractual agreement that provides the basis for the charges (if any) that have been incurred by the Client for Payment Protection Insurance. 4. When MP Financial has received this documentation, MP Financial will contact the client to discuss the next course of action, and whether they wish to pursue their claim based upon MP Financial s assessment of the documentation. 5. Clients will only be required to provide Credit Agreements where they are available. We will seek all documentation from the Creditor, but if the Client has contracts or other information available this will be helpful in speeding up the Claim process. 2

7 CLIENT CONTRACT PPI Compensation Claim MP Financial Important Information (Please Read) The Client has the right to complain directly to the Company at no cost, with the ability to take matters further with the Financial Ombudsman Service. In entering into this agreement the Client acknowledges MP Financial will provide all services required to reclaim and mis sold PPI and will be entitled to the Fee if the Company acknowledges a liability for mis-sold PPI and gives the client redress. 1. Please note you have 14 days (which starts from the date you sign this document) to cancel this contract. There will be no cost to the Client should the contract be cancelled at any time, all costs of investigating your Claim will be borne by MP Financial. 2. All costs related to investigating your claim will be borne by MP Financial. 3. This agreement governs the provision of advice solely related to reclaiming mis-sold PPI and no other financial service. 4. MP Financial will keep you updated fully throughout the claims process; you may contact us by post, , phone or SMS. 5. The Client will only ever be required to pay the Fee, and only in the event MP Financial successfully reclaims mis-sold PPI 6. MP Financial never receives referral fees. 7. MP Financial has no ties with any other third parties. All services are provided solely by MP Financial. 8. Complaints will be handled per our complaints procedure (Enclosed). All complaints should be addressed directly to MP Financial. These will be responded to within 5 working days. Governing Law This Agreement shall be subject to the laws of England and Wales. Regulation MP Financial is regulated by the Ministry of Justice in respect of regulated claims management activities. The authorisation number is [CRM28638] which can be checked on the website Ministry of Justice CRM

8 Declaration I/We agree to appoint MP Financial as our sole representative to pursue a Claim or Claims against the Client s Creditors where there is evidence, concern or other grounds to pursue a Claim for missold PPI. Applicant 1 Applicant 2 Signed: Print Name: Date: Signed: Print Name:. Date Address (Current) Address (Current) Address (Previous) Address (Previous) 4

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