Client details Please input all client 1 details and details for client 2 as appropriate. Please input Client 2 if the client believes they took out the account with another signatory. Plevin Client Details Please fill in one form for each account a client remembers. You may wish to save the client's basic personal details on a separate document or note so that you do not have to ask the client for their personal details more than once.PreviousNextClient 1 First Name(s) Client 1 Second Name PreviousNextEmail PreviousNextClient 1 Date of Birth PreviousNextClient 1 Address (at least one client needs to be currently resident in England or Wales for us to proceed)Address Line 1 Address Line 2 City State Zip Code PreviousNextClient 1 Phone Number PreviousNextClient 1 Address when credit taken out (if different)Address Line 1 Address Line 2 City State Zip Code PreviousNextLender Name 1 PreviousNextClient 2 First Name(s) Client 2 Second Name PreviousNextClient 2 Date of Birth PreviousNextClient 2 AddressAddress Line 1 Address Line 2 City State Zip Code PreviousNextClient 2 Phone Number PreviousNextClient 2 Address when credit taken out (if different)Address Line 1 Address Line 2 City State Zip Code PreviousNextLender Name American Express Argos Card (Home Retail Group) Bank of Scotland Barclaycard Barclays Beneficial Bank (Card) Beneficial Bank (Loan) Blackhorse Capital One Citibank Clydesdale Bank Co-operative Bank Creation Group (formerly Creation Financial Services) Egg Express Gifts Ltd First Direct (Card) First Direct (Loan) First Plus Freemans GE Money Grattan Halifax HFC Bank HSBC (Card) HSBC (Loan) Ikano Financial Services JD Williams/N Brown La Redoute Lloyds TSB Lombard Marks & Spencer MBNA Monument Card National Westminster (Natwest) Nationwide Next Retail OPUS Paragon Mortgages Royal Bank of Scotland (RBS) Santander (formerly Abbey National) Shop Direct Finance Shop Direct Group Tesco Welcome Yorkshire Bank Virgin OtherPreviousNextAre either of the clients in bankruptcy or an IVA? (If so, we cannot proceed because we will not be able to represent the client as straightforwardly.) Yes, bankruptcy Yes, in an IVA No, neitherPreviousNextHave the clients consented to be contacted by Consumer Rights Solicitors? (Needs to be yes) Yes NoPreviousNextAccount details Please take as many of these as possible. PreviousNextWho was your lender? (e.g. bank, credit card company etc.) PreviousNextWhat type of account was this? Mortgage/secured loan against a property Car finance Credit card account Mail order account Payday loan (e.g. Sunny, Peachy, Provident, SafetyNet Credit, Uncle Buck etc.) Guarantor loan (e.g. Amigo) Unsecured loan other than the above OtherPreviousNextHow much credit did you receive as part of this agreement (approximate if not known)? PreviousNextWhat year was the agreement made (approximate if not known)? (If a first mortgage, needs to be from before October 2004 or we cannot proceed - all other types of agreement can start at any time.) PreviousNextIs the account live? PreviousNextIf not live when was it paid off (approx. if not known)? (If before April 2008, we cannot take this claim on.) PreviousNextDo you still have significant arrears or an overdue outstanding balance on this account (e.g. more than 3 missed payments)? (If yes, we cannot proceed) Yes, I am in significant arrears on this account No, I am not in significant arrears on this account Not surePreviousNextPlevin CriteriaPreviousNextDo you know if there was PPI on this account? There was definitely PPI on the account and I have proof. There was definitely PPI on the account but I have no proof. I think there was PPI on this account but I do not know. I have no idea if there was PPI on this account. I have been informed there was no PPI on this account (for advisorPreviousNextWhat was the total amount of the PPI policy on this account (if known)? PreviousNextHave you ever made a PPI claim before to this lender (whether or not it has been answered)? Yes No Can't rememberPreviousNextIf yes, what response did you receive? No response (longer than 1 year ago) Rejection (no PPI on account) Rejection (did not accept that the PPI was mis-sold) Tipping point offer/partial settlement offer not yet accepted Full refund with interest (in this case, we will not be able to take this claim on, please move to the next account) Cannot remember I did not make a PPI claim beforePreviousNextDid you ever use this PPI policy to pay for your account when you were unable to make payments? Yes, I made a significant claim through this PPI policy Yes, I used this PPI policy, but only for a small amount I never used a PPI policy on this account I can't remember whether I used the PPI policyPreviousNextFurther useful detailsPreviousNextBroker name PreviousNextDid your broker inform you that a commission would be paid to them on the PPI policy? Yes No Can't remember OtherPreviousNextWas any of these true of you at the time of taking out this account? I felt pressured to take out the PPI policy or I thought I would not be allowed to take out the credit I did not fully understand the PPI policy if/when I took it out I was on state benefits at the time of this agreement I had a lot of other credit commitments at the time of this agreement I had an income lower than £1,000 a month at the time of this agreement I did not find this agreement affordable once I started to make repaymentsPreviousNextDetails submitted by (advisor name): - Select -Adam JubbHesham ZainOther (please add in comments)PreviousNextAdditional comments (any other relevant information not captured above) PreviousNextDo you want to sign up by email or post? (Email preferred.) Email PostPreviousNextThank you for completing your form Looks like you have a case for us to act on your behalf please uploadProof of Address Choose File Proof of Id Choose File PreviousNextClient 1 Signature Sign Here Client 2 Signature Sign Here Previous Submit Form
