Filling in the Form of Authority. Please ensure you have the lenders name in order to pursue the claim.

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1 Filling in the Form of Authority Please ensure you have the lenders name in order to pursue the claim. 1. Print a claim form for each lender and type of finance. 2. Do not use one claim form for multiple lenders. For Example: Barclays loan and credit card = 2 forms required Two Barclay s loans Barclays loan and Halifax loan = 1 form required = 2 forms required 3. Please provide the following : - All contact and address details including joint account holder if necessary. If you took the finance out whilst at a different address please provide the same in the Address when the finance taken out section - The lender s name and type of finance e.g. credit card, loan or mortgage. - The account number (if you have this information) as it will speed up the processing of your case. You could obtain it from documentation, old bank statements or by contacting your bank/ lender & asking them to locate your account on their records. - Date the finance was taken- please provide the year if exact date is unknown. If you are unable to remember please indicate whether before or after 14 th January How the finance was arranged (via post / internet etc.) and whether the finance is now paid off or still on-going. If any payments have been missed or caused a DMP, IVA or bankruptcy. - Your employment status and sick pay allowance at the time you took out the finance. - At least one reason as to why you believe you were mis-sold the payment protection insurance. If you cannot recall the sales process please indicate the same on the last page of the questionnaire. - If you are unsure if you had PPI please note that questions 2, 3 on page 3 are not applicable and do not require an answer. *50 % of the questionnaire needs to be answered in order for us to be able to process your claim. If you are unsure about any of the questions please indicate this on the form. Please be aware if you do not complete the questionnaire we will have to contact you to obtain the necessary information. 4. Please sign & date (both account holders) and return via or post. Please note: we can provide free post envelopes for the return. If you require any assistance please do not hesitate to contact us on or

2 Date: Your Claim Reference PLEASE WRITE IN BLOCK CAPITALS CUSTOMER DETAILS Main Account Holder Second Account Holder (if applicable) Full Name Current Address Address finance taken out when was Date of Birth Telephone No. Mobile No. Banks Name / Mortgage Lenders Name / Credit Card Company Loan Agreement Number / Mortgage Reference / Credit Card Number Type of Finance (Please circle) Unsecured Loan Secured Loan Mortgage Credit Card Hire Purchase Catalogue I appoint and authorise Money Boomerang Ltd to act upon my/our behalf in accordance with the FSA s Dispute Resolution Guidelines. I give the lender my express authority to deal with Money Boomerang Ltd as if dealing with me/us in person. All correspondence in respect of this matter should be sent directly to Money Boomerang Ltd. I/We have read the Terms & Conditions attached and understand my/our payment obligations. I understand that Money Boomerang will take 25% plus VAT of any financial benefit I receive and I have read the cancellation terms. By signing below I/we accept the company s Terms & Conditions. Signature 1 Signature 2 Date Date Money Boomerang Limited, Adamson House, Towers Business Park, Didsbury, Manchester, M20 2YY - Tel: Company registration Number , VAT Registration Number , registered under the Data Protection Act. Registration Number Z122655X Money Boomerang Ltd is regulated by the Ministry of Justice in respect of regulated claims management activities and that registration is recorded on the Claims Regulation website. Our regulation number is CRM10992

3 HOW YOUR POLICY WAS SOLD PLEASE TRY TO ANSWER THE FOLLOWING QUESTIONS Please CIRCLE your chosen answer Did the agreement include Payment Protection Insurance? Yes No Unsure On what date did you take out the finance and/or PPI? Was the PPI policy taken out with single or joint cover? Single Joint How was the finance/ppi sold to you? Meeting By phone Via a leaflet Via Internet By post Did the lender give you advice or recommend you take out the insurance? Yes No How did you pay for the Insurance? Lump sum added to the loan Monthly Not sure Is the PPI? Finance paid off so no PPI Still running Cancelled early (Date. ) Have you ever made a claim on the insurance policy? Yes No (If Yes please give details) What did you borrow the money for? General expense To buy a car Debt consolidation Home improvements Other (If so please specify here) Have you ever missed payments? Yes No (If Yes Please give details) If Yes are you still in arrears? Yes No 10) Are you currently in any of the following arrangements? DMP IVA Bankruptcy If Yes do the arrangements apply to this particular lender? Yes No At the time you took out the insurance, what was your employment status? Retired Employed Unemployed Self Employed If your employment status has changed since you took out the insurance, please give details (e.g. employed to unemployed) What type of work did you do when you took out the PPI- And what was the name of your employer(s)? Type of Work- Employers name- How long had you been working there at the time you took out the insurance? If you were employed at time you took out the insurance, did you receive any sick pay from your employer? Yes No If Yes, how long for e.g. (1yr 6mths) Did you have any other means of making your repayments? Yes No If Yes please specify At the time you took out the insurance, did you have any health problems or registered as disabled? Yes No

4 PLEASE CONFIRM WHETHER OR NOT THE FOLLOWING APPLY TO YOUR CLAIM: Yes No 1. Were you told the PPI policy was optional? 2. Were you influenced into purchasing the policy? 3. Were you told that purchasing the policy would assist your application? 4. Were you informed of your right to cancel the policy within 30 days? 5. Was the true cost of policy premium explained to you? 6. Was it checked that you were employed (more than 16hrs per week)? 7. Were restrictions surrounding self-employment explained to you? 8. Was it established whether you had existing means of covering the repayments? 9. Was it established whether you had any pre-existing medical conditions at the time of taking out the finance? 10. I honestly believe that if I had been provided with enough information I would have chosen not to take the PPI Please provide any other information which you think may help for example Did the lender give you enough information to consider whether to take the insurance or not? Did they explain the cost (and provide a breakdown) the terms and benefits of the insurance. Do you think they exaggerated or placed unfair pressure on you to take the insurance? Did they say you had to take the insurance was it made clear it was optional? Which branch did you attend to take out the finance? Who arranged it? Did they rush through the process? Were you given time to consider? Why do you think it was mis-sold? Signed- Date- Signed- Date- Please provide as much information as possible about the time when the policy was sold to you. Use rear of form for more space.

5 MONEY BOOMERANG TERMS OF BUSINESS Money Boomerang Limited (Company Number ) is a claims management company authorised and regulated by the Ministry of Justice in respect of regulated claims management activities and that registration is recorded on the claims regulation website. Money Boomerang Limited's registered office is Whittington Hall, Whittington Road, Whittington, Worcester, WR5 2ZX. These terms constitute Money Boomerang Limited's terms of business for the provision of services in respect of claims management activities. Please ensure that you have read these terms of business carefully before signing the Form of Authority. Your attention is particularly drawn to condition 3 regarding liability. Definition of Terms 1.1 'You' and "your" are references to the person whose name is detailed on the Form of Authority. This can also include your partner (if the application is in joint names). 1.2 'The Company' means Money Boomerang Limited. 1.3 'Form of Authority' means the form signed and returned by you to the Company appointing the Company to act on your behalf in respect of your claim. 1.4 'Lender' means any financial institution, bank, mortgage or other financial organisation. 1.5 'Credit Agreement' means an agreement you have entered into with a Lender. This could be in respect of secured or unsecured lending. 1.6 'Compensation' means the total value of both monetary and non-monetary benefits offered by the Lender to you. Monetary benefits include but are not limited to a refund, gesture of goodwill or discount. Non-monetary benefits include but are not limited to a waiver, cancellation, reduction, saving, deduction or re-structuring. 1.7 'Contract' means the contract between you and the Company consisting of the signed Form of Authority and these terms of business. 1.8 Successful settlement means securing an offer from the lender. This includes but is not limited to cash only, cash and finance (future instalment reduction) refunds and offset to arrears. 1. Making a claim You understand that you can pursue your claim yourself, and you can shop around, but you have chosen to instruct the Company to pursue the claim on your behalf. 2. What the Company will do 2.1 The Company will use reasonable efforts to pursue your claim for Compensation against your Lender. The Company will ask the Lender to investigate any other financial arrangement which may give cause to bring a further claim for Compensation and where possible pursue any additional claims for you. Where such additional claims are successful fees shall be payable upon such claims in accordance with condition 6 of this Contract and you agree on signing the Form of Authority to us pursuing such additional claims on your behalf and an additional fee being payable. 2.2 The Company will notify you promptly via written correspondence and/or if the Company decides it cannot pursue an application for Compensation. 2.3 The Company will use reasonable efforts to keep you informed of the progress of your claim. 2.4 The Company will, so far as it is aware and legally able, act in your best interests at all times in pursuing your claim for Compensation. 2.5 The Company in pursuing a claim for Compensation will send a letter of complaint to the Lender and if the Lender does not 3. Liability comply or rejects the complaint or is insolvent, the Company may refer the claim to either the Financial Ombudsman Service (FOS) or the Financial Services Compensation Scheme (FSCS) where appropriate. The FOS and FSCS are available for use by individuals free of charge. 3.1 Save as set out at condition 4.2 the total liability of the Company in contract, tort, misrepresentation, restitution or otherwise arising in connection with the performance of this Contract shall in all circumstances be limited to that which is reasonably foreseeable at the time of forming this Agreement. We foresee that such loses will not exceed the value of the Company fee, based on the overall value of your claim; you should tell us before entering into this Agreement if you believe that your losses will exceed this amount. 3.2 The Company does not exclude or limit in any way liability for: Any liability which it would be illegal or unlawful for the Company to limit or exclude liability for. 4. What you will do 4.1 You will provide all documentation and correspondence which you hold in relation to the Credit Agreement to the Company within 7 days of it being requested and shall ensure (and shall procure that the Lender shall ensure) that all information you provide to the Company (or is provided to the Company on your behalf) is true, accurate and not misleading and you agree to indemnify (and keep indemnified) the Company against all liabilities, costs, expenses, claims, losses or damages arising from each breach of your obligation under this condition You will not authorise anyone else to deal with your Compensation claim whilst the Company is acting for you and this Contract is in force (including any claims management company or law firm). You confirm that you have not previously authorised anyone else to deal with your claim. 4.3 You will not to pursue the claim personally whilst the Company is acting for you and this Contract is in force. 4.4 You will not contact or enter into correspondence with the Lender without express permission of the Company (which may be given at the Company's sole discretion) whilst this Contract is in force. 4.5 You confirm that you will immediately inform the Company of any correspondence you receive from the Lender and without delay send any such correspondence to the Company at Adamson House, Towers Business Park, Wilmslow Road, Didsbury, Manchester, M20 2YY. 4.6 You confirm and warrant that you have not previously claimed or received Compensation nor have you been offered Compensation from the Lender. 4.7 You authorise the Company, in pursuing your claim, to contact the Lender directly and collect any Compensation on your behalf. 5. Performance 6. Fees The Company cannot be held responsible for any delays in the performance of this Contract caused directly or indirectly by any third party (including you, the Lender or any third party). 6.1 If you claim for compensation against the lender is unsuccessful the company will not charge you a fee for its services unless section 8.5 applies.

6 6.2 On a successful settlement of your claim you will pay the Company a fee of 25% plus VAT of the Compensation awarded to you. 6.3 For examples of how the Company's fee is calculated please see Schedule If you receive a payment offer from the Lender you will notify the Company within 48 hours of receipt. 6.5 If you reject a payment offer made by the Lender which is deemed to be consistent with Financial Services Authority or Financial Ombudsman Services guidelines, the Company reserves the right, at its sole discretion, to close your claim and charge you 25% of the offer + VAT for our services or any fees incurred by our associated supplier(s). 6.6 If the Lender sends you the Compensation directly you agree to immediately notify the Company and you will pay the Company its fee based on the value of the Compensation you have received, as set out in paragraph Where there are two names on the Form of Authority, the Company may recover its fee from either of them. 6.8 If the payment is made using a debit or credit card the following charges will be added: 2.5% on Credit card payments and a charge of 2.00 on all Debit card payments. 7. Non Payment of Invoice 7.1 The Company's invoices are payable by you to the Company within 7 days of the invoice date. 7.2 If you fail to pay the amount invoiced within the 7 day period the following table of charges will apply: Reason for charge Invoice not paid within 7 days Charge Amount 30 + VAT The Company issuing a letter chasing payment 12 + VAT to you The Company referring the debt to a debt 50 + VAT recovery company 8. Termination 8.1 The Company may terminate this Contract at any time by giving you 14 days notice in writing or via . No fee will be payable if the Company informs you that your claim is unlikely to succeed subject to you having fulfilled your obligations under this Contract. Should the Company decide not to pursue your claim for Compensation you will be notified promptly of its decision. 8.2 You have the right to cancel this Contract at any time. Your cancellation request must be made in writing to the Company in the form of a written cancellation letter to Adamson House, Towers Business Park, Wilmslow Road, Didsbury, Manchester, M20 2YY. It is recommended that you send any cancellation request to the Company by recorded delivery. 8.3 You have 14 days from signing the Form of Authority in which to cancel this Contract and avoid paying a cancellation fee should you change your mind and no longer wish the Company to pursue your claim for Compensation on your behalf. 8.4 If your cancellation letter is not received within 14 days of you having signed the Letter of Authority we will charge you for our services at our standard charge out rate of 75 per hour to cover our reasonable costs for such preparation, processing and administration costs up to the time that you cancelled the contract in writing. If such termination takes place after the lender has made a reasonable settlement offer our charges will be equivalent to our standard charges; that is 25% plus VAT on the basis that you have received the full benefit of our services. 8.5 If your claim is terminated due to your failure to co-operate a cancellation fee will be payable in accordance with 8.4. If this occurs after a reasonable settlement offer has been received our charges will be equivalent to our standard charges; that is 25% plus VAT. 8.6 The company will not accept any liability for non-receipt of a cancellation request. 8.7 If your claim is terminated due to non-cooperation by you, a cancellation fee will be payable in accordance with condition 8.4. This cancellation fee will be invoiced and posted to you and shall be payable in accordance with condition 7. Any nonpayment of this invoice will be dealt with as at condition 7 above. 8.8 The Company will not accept any liability for non-receipt of a cancellation request. 9. Notices Any notice given to the Company must be made in writing. 10. Data Protection We hold all personal information in accordance with the Data Protection Act By signing the Form of Authority you give the Company express permission to process your personal information for the purposes of assessing your claim and carrying out the Company's duties. This may include where appropriate credit searches for the purpose of identifying financial arrangements you may have entered into. 11. General 11.1 These terms of business shall be governed by and construed in accordance with the laws of England and Wales The English Courts will have exclusive jurisdiction in relation to any claim or dispute arising from these terms of business This Contract is between you and the Company. No other person shall have any rights to enforce any of its terms although the Company shall have the right to assign its rights and obligations under this Agreement to a third party Each of the paragraphs of this Contract operates separately. If any court or relevant authority decides that any of them are unlawful, the remaining paragraphs will remain in full force and effect If the Company fail to insist that you perform any of your obligations under this Contract, or if the Company do not enforce the Company's rights against you, or if the Company delay in doing so, that will not mean that the Company has waived the Company's rights against you and will not mean that you do not have to comply with those obligations. If the Company do waive a default by you, the Company will only do so in writing, and that will not mean the Company will automatically waive any later default by you If you have cause to complain any complaint must be made by telephone, or letter to Complaints Manager, Money Boomerang Ltd, Adamson House, Towers Business Park, Wilmslow Road, Didsbury, Manchester, M20 2YY. An acknowledgement will be provided within 5 working days and a final response issued within 8 weeks. A copy of our Complaints Procedure is available online at or by telephoning Schedule 1 Examples of how the Company's fee is calculated Example A: Example B: Example C: All compensation is cash in hand Compensation includes cash in hand award Compensation is used to offset arrears consumer has Total compensation: 2000 with loan and future instalment reduction on credit card or loan Of which cash 2000 Total compensation: 2000 Total compensation: 2000 Fee 25% 500 Of which cash is 1000 Of which cash is 0 20% 100 Loan reduction 1000 Set off arrears: 2000 Total Fee 600 Fee 25% 500 Fee 25% 500 Consumer receives % % 100 (And no reduction in loan as it is already paid Total Fee 600 Total Fee 600 off in full) Consumer receives 400 Consumer pays 600 (and a reduction of 1000 in future loan (and a reduction of 2000 in their outstanding loan) instalments)

7 Queries? Understanding our Terms and Conditions Understand ing our Terms & Conditions At Money Boomerang it is very important for us to know that our customers understand the terms and conditions under which we act on their behalf. You can find a copy of our terms and conditions on our website at you will see Terms & Conditions clearly marked at the bottom of our home page. Clicking on the link will take you to a full copy of our current Terms and Conditions (Mon-Fri 9am-5pm) T&C: Key Facts You have 14 days in which to cancel your instructions to us & if you cancel after 14 days we set out the hourly rate we apply to work out the fees we shall raise an invoice for upon cancellation. The copy of our Terms and Conditions clearly sets out how our fees are calculated and it is important you understand this. Our fees are 25% plus VAT with regard to successful claims. We will ask the Lender to investigate any other financial arrangements and where possible pursue any additional claims for you To summarise... As we have stated, it is very important to us you understand our terms and conditions so if you have any queries at all please call us at: or us at: and we will be happy to assist you! Money Boomerang Adamson House, Towers Business Park Didsbury Manchester Tel: Fax:

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