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Please complete the following information.
Title
Mr
Miss
Mrs
Ms
Dr
*
Forename:
*
Surname:
*
Email Address:
Telephone (Home):
Telephone (Mobile):
Type of Policy:
Credit/Debit card
Personal loan
Other loan
What year did you take out your policy?
Policy Provider?
Policy / Account Number:
At the time you were sold the cover, were you self-employed?
Yes
No
Did you feel pressurised into taking out the policy?
Yes
No
When you took out this policy, did the sales representative imply that the payment protection insurance was optional?
Yes
No
Were the exclusions of the policy explained to you?
Yes
No
Have you tried to make a claim under this policy?
Yes
No
If so, were you successful?
Yes
No
Any other additional information:
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