Personal Contract Purchase Mis-Selling Claim Intake Form
Use this form to submit details about a PCP agreement and the circumstances of a potential mis-selling claim for review.
Claimant Details
Full Name
*
First Name
Middle Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Contact Method
*
Email
Phone
Text Message
PCP Agreement and Vehicle Details
Vehicle make and model
*
Vehicle registration or purchase year
*
PCP provider or finance company name
*
Agreement start date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Agreement end date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Mis-Selling Claim Information
Reason for believing the PCP was mis-sold
*
Were you told about the key terms and total costs before signing?
*
Yes
No
Not sure
Brief summary of the issue or impact
*
Supporting Evidence and Declaration
Supporting Documents / Evidence
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Declaration
*
I confirm that the information provided is true and accurate to the best of my knowledge, and I understand this submission is for claim review only.
Submit Claim
Should be Empty: