First name:

Surname:

Phone:

Mobile phone:

E-mail Address:

Policy type:

Did the representative explain that the payment protection insurance was optional and NOT compulsory?:

Did the representative lead you to believe that you were more likely to be accepted for the loan if you took PPI:

Were you shown TWO or more repayment options, one with and one or more without PPI:

If you took out joint cover did the representative point out that each person’s cover is limited to a percentage of the monthly payments:

Did the representative explain the monthly cost of the PPI as well as the benefits:

Did the representative discuss the limitations of PPI as well as the benefits:

Did the representative discuss your employment and health history before taking out PPI:

Did the representative enquire whether you had existing cover to protect you:

Did the representative establish your requirements and needs in relation to PPI:

Did the representative fully explain how a single premium policy operates:

Did the representative fully explain the differences between single premium policies and regular premium policies:

Were you informed by the representative that if you settled the loan early you would not be entitled to any rebates on your PPI payments even though the cover would be cancelled:

Did the representative explain in detail the terms and conditions relating to PPI, including the exclusions. For example you must have been in full time employment for at least 6 months prior to taking out the policy or that pregnancy or miscarriage were exclusions:

Did the representative fully explain the terms and conditions of the policy and how they would affect you:

How did you hear about us:

If you heard about us from a telephone advisor, please give us their name: