Plevin Full Form – Maddison Clarke

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Name*
Title First Last
Date of birth*
DD slash MM slash YYYY
Email*
Phone*
Address*
Street Address Address Line 2 City Post Code
Please select any lenders you may have had PPI with. PPI could have been applied to any of your credit cards/store cards, loans or mortgages.*
- Argos Card
- Barclaycard
- Barclays
- Beneficial Bank (Card)
- Beneficial Bank (Loan)
- Capital One
- Citibank
- Clydesdale Bank
- Co-operative Bank
- Egg
- Express Gifts Ltd
- First Direct (Card)
- First Direct (Loan)
- First Plus
- Freemans
- GE Money
- Grattan
- Halifax
- HFC Bank
- HSBC (Card)
- HSBC (Loan)
- JD Williams/N Brown
- Lloyds TSB
- Marks & Spencer
- MBNA
- Monument Card
- Nationwide
- OPUS
- Paragon Mortgages
- Santander
- Shop Direct Finance
- Tesco
- Welcome
- Yorkshire Bank
Do you know when this policy was taken out and ended?
If so, please specify dates to the best of your knowledge.
Have you attempted to claim PPI on this before?*
Did you receive a partial settlement or a tipping point offer?*
Do you have any previous surnames?*
What was your previous surname?*
Do you have any previous addresses?*
Previous Address
Street Address Address Line 2 City Post Code
Is this a joint account?*
Joint account holder's name*
Title First Last
Join account holder's date of birth*
MM slash DD slash YYYY
Does the joint account holder have any previous surnames?*
What is the joint account holders previous surname?*
Information Processing Consent*
I agree
I give permission to Maddison Clarke and Paget Brown UK to retain my information with the purpose of processing my Plevin PPI Claim. I further give permission to Paget Brown to providing my information to barristers, experts, the claimant committee, funders and insurers, tribunals and courts. I authorise the lenders to release any information requested by Paget Brown UK or their legal partners and give legal authority to handle all data concerning my/our affairs with any financial accounts concerning my/our case with Paget Brown UK.
Permission to contact*
I agree
I accept that Maddison Clarke or Paget Brown UK may contact me regarding this claim. More information about our privacy policy
Future Communications
I agree
I consent to Maddison Clarke LTD sending future communications about any relevant services and products.
Signature

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29 Peter Street, Manchester, M2 5QJ

info@maddisonclarke.co.uk

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Maddison Clarke Ltd is registered in England & Wales, registered address 29 Peter Street, Manchester, M2 5QJ. DPA number ZA445087. Maddison Clarke LTD are authorised and regulated by the Financial Conduct Authority. Authorised firm reference number 838445.

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