Client Information and Checklist

Transcription

1 Gilham Capital Ltd, PO Box 362, North Ferriby, HU14 9AL Client Information and Checklist *Customer Name(s) *House Number / Name *Street Name Locality *City County *Post Code *Home Telephone Number *Mobile Number Alternative number Address *Date of Birth *Loan Provider Amount of Loan Date Loan Taken out (approx) Amount of PPI (if known) *Loan Account Number Authority Enclosed Terms of Instruction Enclosed PPI Questionnaire Enclosed *Denotes mandatory field page 1 of 12

2 Helping you claim your Payment Protection Insurance Refund Payment Protection Insurance Terms of Instruction Please Read, Sign and Date below I/We hereby appoint Key Financial Claims to act on my/our behalf as my/our sole representative and claims intermediary in respect of my/our claim for any mis-sold Payment Protection Insurance. I/We shall provide all information required by Key Financial Claims, as requested, by return. I/We shall not enter into any agreement with the Bank/Lender without first consulting Key Financial Claims. Cancellation: Key Financial Claims can cancel this agreement at any time and no fee will be payable by you if we think there are no grounds for a complaint or that your claim is unlikely to succeed. The Company shall have the right to terminate the contract by giving written notice to the client and at any time to immediately terminate the contract if there occurs any material breach by the client of any term of the contract which is irremediable or if remediable is not remedied to the Company s satisfaction within 15 days of a written notice by the Company specifying the breach and requiring it to be remedied: or the client is adjudicated bankrupt; or the client does not follow any recommendations of the Company. The client shall have the right to terminate the contract by giving written notice to the Company within 14 days of signing the contract. In the event that the client terminates the contract after 14 days the Company reserves the right to make a cancellation charge that will reflect the work undertaken by us in pursuit of your claim. Naturally this could be anything up to our full fee at the time. If we have received an acceptance of liability or an offer of compensation, a charge of the greater of three hundred and fifty pounds plus VAT, or 29.5% (including all taxes applicable from time to time, if any) of the claim. Cancellation of the agreement must be done in writing. Compensation: Means the total monies and the full value of benefits offered by the Third Party (i.e. Loan Company, Broker, Lender, IFA or any other company associated with your claim/s) whether as compensation, as a gesture of goodwill, refund, discount or otherwise arising from any claim made by the Company on behalf of the Client for an allegedly mis-sold PPI and/or any reduction in the loan amount outstanding and/or any interest or capital recovered. Where such an offer is revised on appeal, then the higher amount shall be used in order to calculate the amount of the Compensation. I/We understand that if the lender uses my redress monies to reduce arrears on my loan or credit card then the total fee will still be payable to Key Financial Claims. Responsibilities: Key Financial Claims shall: a) Act in the best interests of the client in pursuing any potential claim against any financial institution. b) Provide the client, using the company s experience of payment protection insurance, with impartial advice on the risks and benefits of pursing a claim against any financial institution. c) Advise the client on suitability of any offer of settlement on behalf of any financial institution The Client shall: a) Provide the Key Financial Claims with full and accurate information and not mislead it in any way. b) Respond to any request from Key Financial Claims for instructions or further information without delay. c) Advise Key Financial Claims of any change of address details or contact telephone numbers immediately. Law & Jurisdiction: The law applicable to this contract shall be the law of England and Wales and the parties consent to the jurisdiction of the English courts in all matters affecting this contract. Services provided to the Company may include commencement of legal proceedings to recover compensation, but this is not applicable in every case. The Company makes no representation or warranty to the Client that compensation will be obtained or is in any way guaranteed. The Company reserves the right at any time, at its sole discretion, not to pursue a claim for compensation and will notify the Client in writing if this should occur. page 2 of 12

3 Payment: Key Financial Claims will endeavour to recover all monies owed and undertake to forward any payment from our bank to the client within 7 days from the date received, subject to the agreed fee of 29.5 %( including all taxes applicable from time to time, if any). We require that you promptly pay our fee no later than 10 days after you receive your compensation (if you are paid directly) or if you have no intention of accepting the offer and we recommend that you do so, 10 days after our recommendation. In the event Key Financial Claims takes steps to recover any service charges due and unpaid by the Client to Key Financial Claims, the Client shall pay to Key Financial Claims a recovery fee of 100 plus VAT. An example of our fee - Compensation Awarded is 600, our fee is Amount paid to the Client equals 423. You may be paid directly in cash, or a reduction to your balance may be made. A referral fee will be paid to the Introducer equating to 80% of the fee charged by Key Financial Claims, the exact amount will depend on your particular circumstances. Complaints: Key Financial Claims has an internal complaints procedure, which can be seen below or at Declaration: I/We confirm that I/we have read and understood the terms and conditions have read all documents and by signing below, confirm acceptance of the terms and conditions of the agreement with Key Financial Claims and wish them to act on my/our behalf. This agreement is a binding contract and by signing it you are accepting its terms. Name: Joint Name (if applicable): Address: Postcode: Signed: Joint Signature (if applicable) Date: Date: Key Financial Claims Limited CRM is regulated by the Ministry of Justice in respect of regulated claims management activities page 3 of 12

4 Key Financial Claims Imperial House, Hornby Street. BURY. BL9 5BN To whom it may concern: Letter of Authority 1. Company: Agreement/Account number: 2. Authorisation to Key Financial Claims I/We authorise Key Financial Claims to act on my/our behalf in pursuing my/our claim, as my/our claims intermediary, in respect of advice received from and/or sales made by the company relating to the above and any other account I/we hold or have held with the company. I/We give Key Financial Claims full authority to refer the complaint to the Financial Ombudsman Service if this is believed to be in my/our best interest. 3. Instructions to the company- Please take this letter as my/our instructions to you, (the company ), to deal directly with Key Financial Claims, as my/our claims intermediary, in respect of the complaint and to provide them with any information they request either verbally or in any other media format that they require to pursue my/our complaint. As of the date I/we have signed this letter of authority, we do not wish to receive any correspondence from the company in relation to our complaint. Any wilful failure by the company or any relevant party to not follow my/our express instructions with regard to dealing with Key Financial Claims, whom I/we have contracted with, may render the offending party liable to legal recourse for inducing/procuring a breach of contract, restraint of trade; and breaches of the Competition Act 1988, the Enterprise Act 2002 and Articles 81 & 82 of the EC Treaty. 4. I/We acknowledge that I/we could pursue this complaint against the company myself/ourselves without the involvement of Key Financial Claims, but that I/we have instead opted to engage Key Financial Claims whose fees will be recoverable from me/us. 5. Redress/Compensation This letter constitutes a full assignment by me/us to Key Financial Claims of my/our entitlement to any redress or other monies agreed or awarded to us/me. Such monies will promptly be paid to me/us by Key Financial Claims less their fee for the services carried out by them. I/We have received details of any fees payable contained within our signed letter of engagement. 6. I/We understand that in the event of a successful claim my/our payment protection policy will be cancelled and it is my/our responsibility to arrange replacement cover if required. 7. I/We understand that if the loan or credit card provider uses my redress monies to reduce an outstanding debt balance on my loan or credit card, the total fee will still be payable to Key Financial Claims. Instructions to third party In the event that you need to contact a third party to progress my/our claim for any reason, I/we hereby give my/ our authority and consent for the third party to provide the company and Key Financial Claims with any information they request and may require to pursue my/our claim. Declaration of Truth I/We have read and accepted Key Financial Claims Terms of Instruction and give them full authority to make a claim on my/our behalf. I/We confirm that the information given in this letter is in the best of my/our knowledge accurate and a truthful reflection of my/our recollections of events at the point of sale. Terms of Engagement I/We have read and accept Key Financial Claims Terms of Instruction and give them full authority to make a claim on my/our behalf. Customer 1 Customer 2 Title: First Name: Title: First Name: Surname: Date of Birth: Address: Surname: Date of Birth: Address: Postcode: Signature: Date: Postcode: Signature: Date: Key Financial Claims Limited CRM is regulated by the Ministry of Justice in respect of regulated claims management activities page 4 of 12

5 payment protection insurance: consumer questionnaire WHAT IS THIS QUESTIONNAIRE FOR? This questionnaire is for consumers to register a complaint about the sale of payment protection insurance. It has been designed by the independent Financial Ombudsman Service. The questionnaire asks you for your personal and financial details. These will help the financial business you think is responsible for your complaint to assess your case and decide if it should pay you compensation. WHAT DO I NEED TO DO? Please fill in the questionnaire, giving as much information as you can. It may take you some time to go through the form and get all your facts together. But with all the information in one place, it should mean your case can then be assessed more quickly. Once you have completed the questionnaire, please send it to the financial business that you think is responsible for your complaint. Before you post it, take a photocopy if you can. This will help later on, if you need to refer your complaint to the Financial Ombudsman Service. section A: about you A.1 Please give us your name and contact details your name and contact details details of anyone complaining with you surname title title first name(s) date of birth address for writing to you (include postcode) daytime phone home phone mobile A.2 If someone is complaining on your behalf (eg a relative or solicitor) please give us their details their name Key Financial Claims Limited relationship to you Claims Handler address for writing to them (include postcode) Imperial House, Hornby Street, Bury, BL9 5BN their daytime phone fax their ref A.3 What is the name of the financial business you are complaining about? A.4 What is the policy number of the payment protection insurance you are complaining about? page 5 of 12

6 section B: about the sale of the insurance B.1 When did you take out this payment protection insurance? Can t remember B.2 Did the payment protection insurance provide either single cover (to cover just you) or joint cover (to cover you and your partner)? Single cover Joint cover B.3 How was this insurance sold to you? During a meeting During a phone conversation You were given a leaflet to fill in Over the internet By post Can t remember B.4 Did the financial business give you advice or recommend that you take out this policy? Yes No Can t remember B.5 How did you pay for this insurance? With a one-off single premium paid up-front With a premium paid each month Not sure B.6 What is the current situation with this insurance? The insurance is still running The insurance was cancelled early If so, please confirm the cancellation date. The insurance ended when the loan was paid off (or when the credit-card account was closed) B.7 Have you ever made a claim on the payment protection insurance you are complaining about? Yes No If Yes, please give details including whether the insurance company paid out on the claim or not. payment protection insurance: consumer questionnaire page 6 of 12

7 section C: about the money you borrowed C.1 What was the payment protection insurance sold to cover you for? Loan (personal) Mortgage Catalogue shopping Loan (business) Overdraft Hire Purchase Credit card Store card Not sure What was the account number for this? This number will be different to the insurance policy number you filled in on page 1. C.2 What did you borrow the money (or take the credit) for? For example to purchase a car, for home improvements, for everyday spending, or to pay off other debts. If you borrowed the money to pay off other debts, please give details. C.3 Have you ever missed payments or gone into arrears on this borrowing? Yes No If Yes, please give details. payment protection insurance: consumer questionnaire page 7 of 12

8 section D: about your personal circumstances D.1 At the time you took out this insurance, what was your employment status (and your partner s where relevant)? yourself Employed Self-employed Not working/unpaid work A director of your own company Agency/temporary worker Working fewer than 16 hours a week Retired Student in full or part-time education If so, how many hours are spent in education each week? your partner Employed Self-employed Not working/unpaid work A director of your own company Agency/temporary worker Working fewer than 16 hours a week Retired Student in full or part-time education If so, how many hours are spent in education each week? D.2 If your employment status has changed since you took out the insurance, please give details For example if you were self-employed, but are now employed. D.3 What type of work did you do when you took out the payment protection insurance and what was the name(s) of any employer(s)? yourself your partner Type of work Employer(s) name D.4 How long had you been working there, at the time you took out this insurance? yourself your partner years months years months payment protection insurance: consumer questionnaire page 8 of 12

9 D.5 If you were employed at the time you took out the insurance would you have received any pay from your employer, if you were off work due to an accident or sickness, or if you were made redundant? yourself Yes* No Can t remember Not relevant (as you were not employed) your partner Yes* No Can t remember Not relevant (as you were not employed) *If Yes, what pay would you have received from your employer? D.6 Did you have any other means of making your repayments if you were unable to work through sickness, accident or unemployment? For example this may include savings, other insurance policies, or relying on a relative or friend for help. yourself Yes* No your partner Yes* No *If Yes, please give details. D.7 At the time you took out this insurance, did you or your partner have any health problems or were either of you registered as disabled? yourself Yes* No your partner Yes* No *If Yes, please provide details in Section E on the next page.

10 section E: about your complaint This page is for you to tell us anything else about your complaint including what happened when you took out the payment protection insurance. For example, please tell us any details you remember about: Where the sale took place and who you spoke to at the financial business. The information you were given before you took out this insurance. How the cost, benefits and terms of the insurance were explained to you. The questions you asked before taking out this insurance. Why you decided to take out this insurance. Any changes to your health since you took out the insurance. When I took the loan out I was told I wouldn't get the loan if I didnt take the insurance. I was told I had to take the insurance even though I didnt want it. I do not believe the insurance was suitable for my needs. I would like to be put back into the position that I would have been in, had this not been arranged in the first place, that is to say, refund me any and all monies that I have had to pay towards this arrangement. If you need more space, please use the spare page at the end of this questionnaire. Please send us copies of any documents you have from when you took out the payment protection insurance. And finally, please tell us why you are now unhappy with the insurance? If you need more space, please use the spare page at the end of this questionnaire. payment protection insurance: consumer questionnaire page 10 of 12

11 section F: your declaration Please read and sign this declaration I confirm that I want to make a formal complaint about the sale of the payment protection insurance described in this questionnaire. I confirm that all the information I have given in this questionnaire is true and accurate to the best of my knowledge. sign here You need to sign, even if someone else is complaining on your behalf. If someone is complaining for you, your signature below means you authorise the person named on page 1 to represent you in this complaint. signature date signature date Financial Ombudsman Service, March 2010 The Financial Ombudsman Service owns the copyright to this questionnaire. The questionnaire can be freely copied by third parties involved in bringing or settling financial complaints as long as no changes are made to the text or graphic design, and provided that clear reference is made to the Financial Ombudsman Service s ownership of the copyright. payment protection insurance: consumer questionnaire page 11 of 12

12 question number your answer Please use this page if you need more space for answering any question.