BelmontThornton
PLEASE COMPLETE THE FORMS
AND SEND TO:
Belmont Thornton
Unit 16
Elysium Gate
126 New Kings Road
London
SW6 4LZ
TURN OVER AND START YOUR CLAIM
...Don’t forget you can make as many claims as you like even if
your loan is paid off or you no longer use your credit card.
TURN OVER AND START YOUR CLAIM
...Don’t forget you can make as many claims as you like even if
your loan is paid off or you no longer use your credit card.
CALL 0844 378 0055
OR
0207 717 9447
Claim back my loan payment
protection insurance (PPI)
I would like to...
Claim back my credit
card charges
YES
NO
QTY
YES
NO
QTY
YES
NO
QTY
Claim back my credit
card payment protection
BelmontThornton
CLAIM PACK
Claim back my packaged
bank account charges
YOUR NAME:
YOUR PHONE NUMBER:
JOINT NAME (IF APPLICABLE):
YOUR EMAIL ADDRESS:
YOUR CONTACT DETAILS
SIGN & DATE
SIGNATURE: DATE:SIGNATURE: DATE:
...two signatures if joint policy!
WHY DO YOU THINK YOU MAY HAVE BEEN MIS-SOLD?
(E.G. I DIDN’T REALISE IT HAD BEEN ADDED, I WAS LED TO BELIEVE IT WAS NOT OPTIONAL, I WAS LED TO BELIEVE I NEEDED IT WHEN I DIDN’T.)
THIS CLAIM IS FOR...
USE SEPARATE FORM FOR EVERY CLAIM
Card Payment Protection
Credit Card Charges
Packaged Bank Account
EMPLOYED FULL TIME CONTRACTING SELF EMPLOYED UNEMPLOYED EMPLOYED
PART TIME HOMEMAKER RETIRED
WHEN YOU TOOK OUT YOUR LOAN OR CREDIT CARD
WERE YOU ENTITLED TO SICK PAY FROM YOUR EMPLOYER?
DID YOU HAVE ANY EXISTING MEDICAL CONDITIONS?
WAS THE FULL COST OF THE PPI/CREDIT CARD CHARGE EXPLAINED TO YOU? WAS IT MADE CLEAR THAT PPI WAS OPTIONAL? (LOAN/CARD PPI ONLY) ARE YOU CURRENTLY IN AN IVA OR DEBT MANAGEMENT PLAN?
WAS PPI ADDED TO YOUR LOAN OR CARD?
YES
PLEASE TICK
NO
UNSURE
FULL NAME (OR NAMES IF JOINT POLICY) DATE OF BIRTH (DATES OF BIRTH IF JOINT)
LOAN / CREDIT CARD PROVIDER / BANK (E.G. ABBEY, NATWEST, BARCLAYCARD ETC.)
LOAN REFERENCE / CREDIT CARD NUMBER / BANK ACC & SORT CODE ADDRESS
/
POST CODE:
WERE YOU...
OTHER
You could be just
30 seconds away
from starting your
claim!
THIS AUTHORITY RELATES TO THIS AND ALL PREVIOUS AGREEMENTS WITH YOUR COMPANY
Authorisation to Belmont Thornton
I/We authorise Belmont Thornton to act on my/our behalf in pursuing my/our Claim in respect of advice received from and/or sales/charges made by the Company relating to the above loan/credit card / bank account. I/We give Belmont Thornton full authority to refer the Claim to the Financial Ombudsman Service if this is believed to be in my/our best interest.
Terms of Engagement
I/We have read and accept Belmont Thornton’s Terms of Engagement and give them full authority to make a Claim on my/our behalf.
Instructions to the Company
Please take this letter as my/our instruction to you, the Company, to deal directly with Belmont Thornton in respect of the Claim and to provide them with any information they request and require to pursue my/our Claim. I/We acknowledge that I/we could pursue this Claim against the Company myself/ourselves without the involvement of Belmont Thornton but that I /we have instead opted to engage Belmont Thornton whose fees will be recoverable from me/us.
Redress/Compensation
I/We hereby instruct you to pay any award of compensation to Belmont Thornton who will hold the money on my/our behalf. The redress is to be paid to: Belmont Thornton Client Account. Such monies will promptly be paid to me/us by Belmont Thornton less their fee for the services carried out by them.
To Whom It May Concern
I/We understand that in the event of a successful claim, my/our payment protection policy relating to the above loan/credit card /packaged bank account products will be cancelled and it is my/our responsibility to arrange replacement cover if required.I/We understand that if the loan company or credit card provider uses my/our redress monies to reduce an outstanding debt balance on my/our loan or credit card a full fee will still be immediately payable to Belmont Thornton.
Instructions to Third Party
In the event that you need to contact a third party to progress my/our claim for any reason, I/we hereby give my/our authority and consent for the third party to provide the Company and Belmont Thornton with any information they request and may require to pursue my/our Claim.
Declaration of Truth
I/We have read and accept Belmont Thornton’s Terms and give them full authority to make a Claim on my/our behalf. I/We confirm that the information given in this letter and in this leaflet is to the best of my/our knowledge accurate and a truthful reflection of my/our recollections of events at the point of sale.
I/We confirm that we have enclosed any relevant documentation we hold evidencing our claim.
I/We confirm that I am/ We are not in a Debt Management Plan / IVA / Bankrupt. (Note: If you are we cannot make a claim).
Loan Payment Protection (PPI)
DO YOU HAVE MORE THAN ONE CLAIM?
MOST PEOPLE HAVE MORE THAN ONE CLAIM.
SIMPLY FILL IN A SEPERATE FORM FOR EACH CLAIM.
SIGN & DATE
SIGNATURE: DATE:SIGNATURE: DATE:
...two signatures if joint policy!
WHY DO YOU THINK YOU MAY HAVE BEEN MIS-SOLD?
(E.G. I DIDN’T REALISE IT HAD BEEN ADDED, I WAS LED TO BELIEVE IT WAS NOT OPTIONAL, I WAS LED TO BELIEVE I NEEDED IT WHEN I DIDN’T.)
Card Payment Protection
Credit Card Charges
Packaged Bank Account
EMPLOYED FULL TIME CONTRACTING SELF EMPLOYED UNEMPLOYED EMPLOYED
PART TIME HOMEMAKER RETIRED
WHEN YOU TOOK OUT YOUR LOAN OR CREDIT CARD
WERE YOU ENTITLED TO SICK PAY FROM YOUR EMPLOYER?
DID YOU HAVE ANY EXISTING MEDICAL CONDITIONS?
WAS THE FULL COST OF THE PPI/CREDIT CARD CHARGE EXPLAINED TO YOU? WAS IT MADE CLEAR THAT PPI WAS OPTIONAL? (LOAN/CARD PPI ONLY) ARE YOU CURRENTLY IN AN IVA OR DEBT MANAGEMENT PLAN?
WAS PPI ADDED TO YOUR LOAN OR CARD?
YES
PLEASE TICK
NO
UNSURE
FULL NAME (OR NAMES IF JOINT POLICY) DATE OF BIRTH (DATES OF BIRTH IF JOINT)
LOAN / CREDIT CARD PROVIDER / BANK (E.G. ABBEY, NATWEST, BARCLAYCARD ETC.)
LOAN REFERENCE / CREDIT CARD NUMBER / BANK ACC & SORT CODE ADDRESS
/
POST CODE:
WERE YOU...
OTHER
THIS AUTHORITY RELATES TO THIS AND ALL PREVIOUS AGREEMENTS WITH YOUR COMPANY
Authorisation to Belmont Thornton
I/We authorise Belmont Thornton to act on my/our behalf in pursuing my/our Claim in respect of advice received from and/or sales/charges made by the Company relating to the above loan/credit card / bank account. I/We give Belmont Thornton full authority to refer the Claim to the Financial Ombudsman Service if this is believed to be in my/our best interest.
Terms of Engagement
I/We have read and accept Belmont Thornton’s Terms of Engagement and give them full authority to make a Claim on my/our behalf.
Instructions to the Company
Please take this letter as my/our instruction to you, the Company, to deal directly with Belmont Thornton in respect of the Claim and to provide them with any information they request and require to pursue my/our Claim. I/We acknowledge that I/we could pursue this Claim against the Company myself/ourselves without the involvement of Belmont Thornton but that I /we have instead opted to engage Belmont Thornton whose fees will be recoverable from me/us.
Redress/Compensation
I/We hereby instruct you to pay any award of compensation to Belmont Thornton who will hold the money on my/our behalf. The redress is to be paid to: Belmont Thornton Client Account. Such monies will promptly be paid to me/us by Belmont Thornton less their fee for the services carried out by them.
To Whom It May Concern
I/We understand that in the event of a successful claim, my/our payment protection policy relating to the above loan/credit card /packaged bank account products will be cancelled and it is my/our responsibility to arrange replacement cover if required.I/We understand that if the loan company or credit card provider uses my/our redress monies to reduce an outstanding debt balance on my/our loan or credit card a full fee will still be immediately payable to Belmont Thornton.
Instructions to Third Party
In the event that you need to contact a third party to progress my/our claim for any reason, I/we hereby give my/our authority and consent for the third party to provide the Company and Belmont Thornton with any information they request and may require to pursue my/our Claim.
Declaration of Truth
I/We have read and accept Belmont Thornton’s Terms and give them full authority to make a Claim on my/our behalf. I/We confirm that the information given in this letter and in this leaflet is to the best of my/our knowledge accurate and a truthful reflection of my/our recollections of events at the point of sale.
I/We confirm that we have enclosed any relevant documentation we hold evidencing our claim.
I/We confirm that I am/ We are not in a Debt Management Plan / IVA / Bankrupt. (Note: If you are we cannot make a claim).
Loan Payment Protection (PPI)
THIS CLAIM IS FOR...
USE SEPARATE FORM FOR EVERY CLAIM
NO WIN NO FEE - ONLY 35% + VAT
*Have you completed a separate form for each claim
you would like to make?
Have you signed and dated every form?
Has any joint policy holder also signed?
Do you have any original documentation relating to
your claim? (Please send)
BEFORE YOU POST ME...
Any questions?
Need more forms?
Call:
0844 378 0055
OR
0207 717 9447
E-mail:
info@belmontthornton.com
Address:
Unit 16
Elysium Gate
126 New Kings Road
London SW6 4LZ
Belmont
Thornton
* Belmont Thornton operates on a "No Win No Fee" basis. This means that there are no upfront costs to pay. Our fee only becomes payable on a successful outcome of a claim. A cancellation fee is payable if you decide that having instructed Belmont Thornton to act on your behalf, and after 14 days of signing your Letter of Authority, you do not wish to continue pursuing your claim with us. The cancellation fee is the reasonable costs incurred for the work undertaken. Please see our terms of engagement.
