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PPI Check Form

Required Fields *
Title *  

Title (Other) *  

First Name *  

Middle Name(s)  

Surname *  

Date of Birth (In Format DD/MM/YYYY) *  

 /  / 

Address *  

Postcode *  


If your address has changed since taking out PPI, please provide the address you lived at when you took out the PPI policy.

Required Fields *
Previous addresses  

Telephone Number  

Mobile Number  

Please tell us a time that's convenient to call.

If appropriate, we'll call you during our review. Please bear in mind we can only call between 8am - 8pm Monday to Friday.

Required Fields *
Please select at least one option below  

Morning (9am - 12pm)
Afternoon (12pm - 5pm)
Evening (5pm - 8pm)

Please confirm which product(s) your query relates to *  

Personal Loan
Credit Card
Business Product - i.e. Business Loan/Overdraft
Blackhorse Finance Product

Account/Policy Numbers (if known)  

Business/Company Name  

Business/Company Address  

Previous Business/Company Name and/or Address (if applicable)  

Please provide any further details you may have regarding your PPI query *  

Please use the box below to tell us if you require additional support (e.g. someone helps manage your affairs), or have a physical or mental health condition. Also if you need us to communicate with you in a different format (e.g. large print), let us know here.

Please note, by completing this section you consent to us recording all details you share, which might include sensitive information such as your health. This will only be used in relation to your PPI complaint.

Required Fields *
Additional support requirements