ENDOWMENT MORTGAGE QUESTIONNAIRE (EMQ) This questionnaire asks you for your personal and financial details at the time your endowment policy was arranged. We need these details to be able to handle your complaint in a fair and reasonable manner. IMPORTANT TO ENABLE US TO RESOLVE YOUR COMPLAINT PLEASE ENSURE YOU COMPLETE AND RETURN THIS FORM TO US AS SOON AS YOU CAN AND, IF POSSIBLE, WITHIN THE NEXT TWO WEEKS. WE WILL BE UNABLE TO PROGRESS YOUR COMPLAINT UNTIL YOU DO SO. To calculate any offer that may be due, we need you to provide specific information about your mortgage. If you do not provide this information we will have to use some assumptions to calculate any offer that may be due. We will notify you, if appropriate, of any assumptions made. Please help us by giving as many details as you can. We appreciate that your mortgage and endowment policy were arranged some time ago and that you may need to provide approximate answers. Please tell us where this is the case. After you have completed the front page, there are 5 sections to this questionnaire. If you have any questions or would like help filling in the questionnaire please contact us on 0870 010 0215 and we will be happy to go through it with you. Barclays Case Reference. r name (1 st policy holder) r date of birth r partner s name (2 nd policy holder) r partner s date of birth We would like as much information as possible at this stage so that we don t have to keep asking you more questions later on. However, in some instances it may help us if we could discuss your concerns in more detail during the course of our investigation. If you are happy for us to call you during normal office hours, please provide your telephone numbers. Home:.. Work:.... Mobile:. 1
SECTION 1 PERSONAL DETAILS This section asks for basic details about you and your circumstances at the time you took out your mortgage endowment. We need this information to decide if the policy was suitable for you. 1. What type of work did you do at the time you took out the policy what was your job title? r partner 2. What were your annual earnings (before tax) at the time you took out the policy? r partner 3. What are your current annual earnings (before tax)? r partner 4. At the time of taking the policy were you a: Smoker n-smoker 5. Did you have any financial dependents at the time you took out the policy? 6. Did you have any existing life cover in place at the time you took out the policy? Please provide the details below Please proceed to Q6 Product Type Provider Policy Number Sum Assured Lives Assured 7. Did you already have any savings or investments at the time you took out the policy? Please select all that apply below Please proceed to Q7 PEPs, share based ISAs Stocks and shares Bank accounts, national saving, cash ISAs Other Investments Please use the box below to provide more details of these savings and investments; continue on a separate sheet if required. Investment Type Provider / Fund Details Amount Invested Date Invested 8. Did you cancel or surrender any of these investments or policies to take out the endowment policy? N/A Please proceed to Q8 Please proceed to Q8 Please provide details of the cancellation or surrender below 9. Did you discuss your mortgage and endowment policy with anyone before taking it out? Please select all that apply below Please proceed to Section 2 The mortgage lender An Insurance company An estate agent Other 10. If you met with a member of our staff before taking out the policy where did you meet them? r Home r workplace Other A branch Company Office N/A 2
SECTION 2 RETIREMENT / PENSION PROVISION This section asks for information about your retirement plans at the time you took out your mortgage endowment. We need this to decide if an endowment policy was suitable for you. 1. Do you have a concern about your policy running into retirement? Please fully answer the questions below Please proceed to section 3 2. At the time you took out the policy at what age did you expect to retire? 3. What age do you currently expect to retire (if different)? r partner r partner 4. At the time you took out the policy, what income did you expect to have in your retirement? (including pensions, income from continuing employment, investment income etc) r partner 5. Did you ever query why your endowment mortgage runs past your retirement date? Please provide details of discussion below Please proceed to Q6 6. What were your plans for paying your mortgage premiums at the time you took out the policy? Have these plans changed? 7. Did you or your partner have a personal pension or any deferred pension arrangements? Please provide details of when your Please proceed to Q8 employer started making contributions 8. Were you or your partner part of an occupational or deferred pension scheme? Please provide details of the scheme(s) Please proceed to section 3 Scheme Type Accrual rate % Start date Premiums Scheme retirement age Years of pensionable service 9. Do you contribute to the scheme? 10. Have you made any free standing additional voluntary contributions (FSAVCs) or additional voluntary contributions (AVCs)? Please provide details below Please proceed to section 3 Scheme Date of contribution Contribution amount 3
SECTION 3 ENDOWMENT POLICY DETAILS This section asks specific questions regarding the endowment policy about which you have complained. This will help us understand how the policy was set up to support your mortgage. 1. Who was the provider of your policy at the time you took it out? 2. What was the policy number? 3. When did the policy start? / / 4. Was the policy a low start plan? 5. At the time you took out your policy, what were the premiums payable? Monthly Yearly 6. Have you had any premium increases since this time? Please provide details of below Please proceed to Q7 Date(s) of increase Amount(s) of increase 7. Is the policy still being used as a means to repay your mortgage? Please proceed to Section 4 Please proceed to Q8 8. Have you sold the policy on the Tradeable Endowment Policy Market (TEP)? Please provide the details below Please proceed to Section 4 Policy sold to Date of sale Sale Amount SECTION 4 MORTGAGE DETAILS This section asks for details of the mortgage loan held over the term of the endowment policy. We will need this information to be able to assess your complaint in a fair and reasonable manner. 1. At the time of taking the mortgage were you a: First time buyer Existing homeowner Please proceed to Q2 Please proceed to Q3 2. Was your mortgage arranged under the Right to Buy scheme? Please provide details of your monthly Please proceed to Q4 rent prior to the mortgage Please proceed to Q4 3. Was the mortgage taken to cover a second property? 4
4. Please provide the details of your address (including postcode) at the time the mortgage was taken. 5. Please provide the details of the mortgage agreed at the outset. Mortgage Lender Mortgage Type Start Date Initial Amount 6. Have you increased your initial borrowing? Please provide the details below Please proceed to Q7 Date(s) of borrowing increase(s) Amount(s) borrowed 7. During the period you held your endowment policy, did you change your mortgage or lender? Please provide the details below Please proceed to Q8 Lender: Date of change: Mortgage Type: Lender: Date of change: Mortgage Type: Interest Only Repayment Interest Only Repayment Part Repayment Offset Part Repayment Offset 8. Have you made any lump sum or over payments to your mortgage over this period? Please provide the details below Please proceed to Q9 Date(s) of lump sum(s) / overpayment(s) Amount(s) 9. Have you had any special rates, other than standard variable rate (SVR), applied to your mortgage? Please provide the details below Please proceed to Q10 Rate: % Rate: % Rate: % Start Date: Start Date: Start Date: End Date: End Date: End Date: Fixed Capped Fixed Capped Fixed Capped Discount Tracker Discount Tracker Discount Tracker Other Other Other 10. Have you repaid your mortgage? Please provide the date of repayment Please proceed to Section 5 5
SECTION 5 DECLARATION We require the signatures of all current lives assured on the policy in order to progress with your complaint. Without this we will be unable to complete our investigation and your case may be delayed and in some instances closed. Please read the following before you sign this form: I/we confirm that the information provided is to the best of my/our belief and recollection true and accurate. I/we understand that where I/we have not provided information assumptions may have to be used to calculate any offer that may be due. I/we understand that this could result in a lower or higher offer being made than if the actual information was used. I/we understand that deliberately providing untrue information may result in civil and criminal proceedings including fraud. BARCLAYS CASE REFERENCE NO: r Full Name (Printed) r Partners Full Name (Printed) (1 st Policyholder) (2 nd Policyholder) Signed Signed Date Date IMPORTANT TO ENABLE US TO RESOLVE YOUR COMPLAINT PLEASE ENSURE YOU COMPLETE AND RETURN THIS FORM TO US AS SOON AS YOU CAN AND, IF POSSIBLE, WITHIN THE NEXT TWO WEEKS. WE WILL BE UNABLE TO PROGRESS YOUR COMPLAINT UNTIL YOU DO SO Please return to: Client Relations Leicester LE87 2AD Lastly we thank you for your time and patience in completing this questionnaire. 6