In Principal Submission Form

Claims Master Limited, CFS Business Park, Coleshill Road, Sutton Coldfield, West Midlands B75 7FS.

Registered in England & Wales No. 6752953. Claims Master Ltd is regulated by the Ministry of Justice in respect of regulated claims management activities no. CRM17856.

Website Designed and Hosted by Weboriel.

Claims Master Limited

New Claim Enquiry Form (* denotes compulsory field)

Name, Phone,
Post Code and
Email address
are all required
to process your
initial claim
enquiry.

We do not need
your actual
address at this
stage, but if
you want to provide
it, it will be kept
confidential.

CLAIM DETAILS

If this is for a
Loan, please
fill in these
details.

CLAIM DETAILS

If this is for a
Credit Card,
please fill in
these details.

CLAIM DETAILS

If this is for a
Payment
Protection
Policy, please
fill in these
details.

Is there anything
else you want to
tell us ? If so
please do so
here

Title

First Name *

Surname *

Client Reference number (if known)

Contact Telephone *

Email Address *

Postcode *

House Name or Number

Street or Road

Town

Type of Loan.

(if "Other", give details)

Joint / Single

Business

Lender

Was PPI Added ?

Amount Borrowed

Start Date

Over how many years ?

Monthly Payment

Approximate Balance Outstanding

Have you missed any payments ?

Purpose of the Loan ?

Do you have a copy of the agreement available ?

Type of Card.

( if "Other", please give details )

Personal or Business ?

Card Issuer

Is PPI included ?

Agreement Start Date:

(this may be different from the start date on your current card)

Approximate Balance

Do you have a copy of the agreement available ?

Have you missed any payments ?

Insurance Premium Type.

Attached to:

( If "Other" please give details )

Insurance Provider

Term ( if known )

Have you ever claimed on the policy ?

If "Yes", did it pay out ?

Is there anything else you want to tell us ?