Unfair Credit Agreement & Mis-sold Payment Protection Insurance Claim Pack Contents: Client Disclaimer & Audit Confirmation About You Loan & Credit Card Questionnaire: fill out one form for each credit card or loan Section 77/78 Form: fill out one form for each credit card or loan Form of Authority: fill out one form for each credit card or loan Please leave the section entitled, Lender s address blank. We will fill in the correct address on your behalf. Complete, sign and date the above forms and return to: Debt Clear Solutions Ltd Suite 501 International House 223 Regent St London W1B 2QD Please include a cheque/postal order for 11.00 made payable to each loan or credit card provider. By signing the Client Disclaimer you are entering into a legally binding agreement with Debt Clear Solutions Ltd. Regulated by the Ministry of Justice in respect of regulated claims management activities. Auth. : CRM15623
Client Disclaimer and Audit Confirmation I/We wish to confirm that I/We have read the terms and conditions on www.debtclearsolutions.com, plus all the relevant paperwork and documentation supplied by Debt Clear Solutions Limited in respect of my/our claim. I/we also confirm my/our comprehension of all verbal advice and information whether in person or by telephone including, but not limited to, the following: I/We must wherever possible continue to maintain my/our contractual obligations on any relevant current credit agreements that I/we have in place whilst my/our claim is in process. In the event that my/our personal circumstances hinder or prevent me/us from being able to maintain said payments, Debt Clear Solutions Ltd will not accept any liability in respect of lender actions or other agencies pursuing means of obtaining payment. r will Debt Clear Solutions Ltd accept any liability in the case of legal action being instigated or any adverse effects to my/our credit file. In any case, I/we indemnify Debt Clear Solutions Ltd of any liability as a result of any nonpayments. I/we understand that I/we may be sent forms from Debt Clear Solutions Ltd at any time during the claim process as part of the ongoing claim and that I/we am wholly responsible for the completion and return of the forms to assist in the claim process. I/We understand the fee of 95.00, per credit agreement, and/or potentially mis-sold payment protection insurance claim, is payable upfront to Debt Clear Solutions. This fee is non-refundable. The claim is NOT guaranteed to be successful. I/We understand we have to also provide a cheque/postal order for 11.00 made payable to the provider of our loan/credit card/mortgage, for each claim. Debt Clear Solutions Ltd has a complaints handling procedure which states that if at any time I/we have reason for complaint or if I/we am not satisfied for any reason, I/we will, in the first instance, illustrate my concerns in writing to: Mr A Mason (Compliance Manager) Suite 501, International House 223 Regent St London, W1B 2QD I/We understand that if my enquiry was introduced to Debt Clear Solutions Ltd from a third party who is registered to refer clients to Debt Clear Solutions Ltd, that Introducer will be paid for the referral upon acceptance of my/our full application to proceed. I/We have read and agreed to the terms and conditions as set out and illustrated in the Unfair Credit Agreement Information Pack. Applicant Signature (1): Applicant Signature (2): Regulated by the Ministry of Justice in respect of regulated claims management activities. Auth. : CRM15623
About You Full Name(s) (not initials please) Client 1 Client 2 Contact Telephone(s) (H).. (W).. (M).. (H).. (W).. (M).. E-mail Address Date(s) of Birth Best Time to Call Best Person to Contact Correspondence Address (including post code) If this claim pack has been completed in the presence of a Claims Assistant, s/he should add his/her stamp or name, address & telephone number here. Regulated by the Ministry of Justice in respect of regulated claims management activities. Auth. : CRM15623
IMPORTANT DECLARATION: Loan / Credit Card Questionnaire Please complete one Questionnaire PER Loan I DO / DO NOT (PLEASE CIRCLE AS APPROPRIATE) HAVE A COPY OF THE LOAN AGREEMENT.... (PLEASE SIGN ABOVE TO CONFIRM THE DECLARATION) If you do have a copy, please send it to us attached to this questionnaire. If you do not have a copy, don t worry. We can still investigate your claim. In either case, please answer the below questions as fully as possible. Credit Agreement Information PLEASE CALL YOUR LENDER IF YOU DO NOT KNOW THE ANSWERS. THEY ARE REQUIRED TO PROVIDE YOU WITH THIS INFORMATION. 1 What is the Loan / Credit Card Mortgage Account Number? 2 Name of the lender? 3 If a Loan, how much did you borrow? 4 Term of the Loan? Years 5 Approx. what date was the Loan / Credit Card / Mortgage taken out? 6 Has your Loan / Credit Card / Mortgage been repaid in full? 7 How much is left to pay on your Loan / Credit Card? 8 9 Payment Protection Insurance (PPI) Information Does the Loan / Credit Card / Mortgage currently have PPI? Has the Loan / Credit Card / Mortgage ever had PPI in the past? If NO, go to Question 24 10 If, when was it cancelled? 11 12 Were you told you had to have PPI cover to get your Loan / Credit Card / Mortgage? Was the PPI cover added to your Loan / Credit Card / Mortgage without your prior knowledge? 13 Was the full cost of the PPI policy explained to you? 14 15 16 Were you asked whether you already had existing protection to cover redundancy, accident or illness? Were you advised that PPI would not cover you if you were self-employed or had a pre-existing medical condition, or if you were over a certain age? At the time of taking out the policy were you asked any questions about your medical history? Regulated by the Ministry of Justice in respect of regulated claims management activities. Auth. : CRM15623
Payment Protection Insurance Information (Continued) At the time of taking out the policy, did you have any existing medical conditions? (such as a bad back or mental illness) that had previously stopped you from working? If YES, then please provide brief details: 17 18 If your answer to question 17 is, were you informed by the Advisor that if you suffered with the same condition again it would probably not be covered by the insurance? 19 Are you currently making a claim for benefits on the policy? 20 If you ever claimed against the policy in the past, was it successful? 21 Have you previously complained to the policy provider? If, please provide copies of your complain and the firm's response. 22 When you took out the loan what was your employment status? 23 24 Were you advised by the broker or your lender that a commission might be paid to or by them for arranging the policy? Are you currently in an IVA, debt management program or bankrupt? Policy Holder 1 Policy Holder 2 Employed (Full Time) Employed (Full Time) Employed (Part Time) Employed (Part Time) Unemployed Unemployed Self Employed Self Employed Fixed Term Contract Fixed Term Contract Retired Retired Student Student Home Maker Home Maker Adverse Credit Information 25 Are you up to date with the monthly payments? 26 If not up to date, how many months have you missed? Months 27 Have you stopped paying altogether? 28 Is the lender or a debt collector chasing you for payment with letters, phone calls, home visits or court action? 29 Would you like us to negotiate with your creditors to help you to freeze your interest and reduce your monthly repayments? Account Holder 1 Account Holder 2 Signed: Print Name: Signed: Print Name: Regulated by the Ministry of Justice in respect of regulated claims management activities. Auth. : CRM15623
Form of Authority Account Holder Name (1) Address: Post Code: Telephone Number: Account Holder Name (2) Address: Post Code: Telephone Number: Agreement Type (tick relevant box) Loan Credit Card Name of Lender? (the firm or licensee(s)): Lender s address (if known): Loan Agreement / Credit Card : Loan Agreement Start End I/we further authorise and insist that you the firm and/or licensee(s) release to Debt Clear Solutions Ltd, (the company), any information that may be requested including, but not exclusively, information under Section 77/78 of the Consumer Credit Act 1974, and all data requested via a Subject Access Request. These requests may be in writing, by telephone, email, fax or as directed, in accordance with the Rights of Data Subjects and Others under the Data Protection Act 1998. Please be advised that any wilful failure to comply with this or any other subsequent instruction made by the company acting on my behalf, whom I/we have legally contracted, within the legal requirements as set out by the Compensation Act 1998. The Enterprise Act 2002 and Articles 81 & 82 of the EC Treaty may leave you, the firm or licensee(s), open to legal recourse. Signed (1) Date of birth Signed (2) Date of birth Print: Print: Regulated by the Ministry of Justice in respect of regulated claims management activities. Auth. : CRM15623
Section 77/78 Request As prescribed under Section 77/78 Consumer Credit Act 1974 Name of Lender: Address of Lender: I/We (Client Name): Current Client Address: Have you changed your address in the last 3 years? (Please tick): o o NO YES - Please provide previous address details on separate sheet. Client Address (at time agreement was executed): Account Name(s): Loan Agreement / Credit Card Number: I/We instruct you, the creditor, to supply Debt Clear Solutions Ltd with a copy of the above regulated credit agreement (if any), including any documents referred to herein and a statement of account under the legislation contained with S77 and S78 of the Consumer Credit Act 1974. Under S189 of the Consumer Credit Act, you are obliged to provide these documents whether you are the original creditor or not. If you, the creditor, under an agreement, fail to comply with this request within 12 days, you will be in default, and as a consequence not entitled to enforce the agreement. Where the default continues for one month, you, the creditor, commit an offence. Signed (1): Date of Birth: / / Signed (2): Date of Birth: / / Print: / / Print: / / Regulated by the Ministry of Justice in respect of regulated claims management activities. Auth. : CRM15623