Commission complaint form

Transcription

1 Commission complaint form When should I use this complaint form? This form is to be completed by customers of Canada Square Operations Limited (formerly known as Egg Banking plc), part of Citigroup, which handles complaints arising from insurance products from Canada Square Operations Limited, CitiFinancial Europe Ltd or Future Mortgages Ltd (now known as Dukinfield Mortgages Ltd) who have held Payment Protection Insurance ( PPI ) and/or Card Repayment Protection ( CRP ) and wish to make a complaint regarding the levels of commission associated with the sale of their PPI and or CRP and not the mis-sale of the PPI and/or CRP policy. If you wish to make a PPI or CRP mis-sale complaint, please complete the PPI form on the website. The form asks for personal and financial details relevant to your PPI or CRP and your relationship with Egg Banking Plc, CitiFinancial Europe Ltd or Future Mortgages Ltd. Canada Square Operations Limited (formerly known as Egg Banking plc), part of Citigroup, handles all complaints regarding insurance-related products from Egg Banking Plc, CitiFinancial Europe Ltd or Future Mortgages Ltd (now known as Dukinfield Mortgages Ltd) and are the data controllers of the information you submit using the Commission Complaint Form. We will use these details in investigating your complaint and to get in touch with you about your complaint. For more information of how we use your details please see our Privacy Statement. By submitting these details using this form, you are confirming you wish to raise a complaint about the products and or businesses you indicate below. Please don t worry if you can t remember all of the information or you don t have any paperwork you can still complete the request and return this to us at the below address. Please complete this form using a Black Pen. Canada Square Operations PO Box 4903 Worthing BN99 3AR Page 1

2 Your Name and Contact Details Title: First Name: Middle Name: Surname: Previous Surname: DOB: Mobile Number: Daytime Tel: Current Address: (house name or number) Previous Address 1: Page 2

3 Previous Address 2: Previous Address 3: Is anyone else complaining with you? By completing this section with the details of a joint product or policy holder, you are confirming you wish to raise a complaint on behalf of both yourself and the joint product or policy holder. You are also giving us consent to process the joint product or policy holder s details in line with the terms of our Privacy Statement, details of which you can read on our website. If you only wish to raise a complaint for yourself, even if the product or policy was held in joint names, answer this question as no and leave this section blank. If you provide information about a joint policy or product holder, you must ensure that you have consent, or are otherwise entitled to provide this information to us. Page 3

4 Joint Complainant Details Title: First Name: Middle Name: Surname: Previous Surname: DOB: Mobile Number: Daytime Tel: Current Address: (house name or number) Previous Address 1: Page 4

5 Previous Address 2: Hhouse name or number Previous Address 3: Which Company/Product are you complaining about? Page 5

6 What is the policy number or account number of the product you are complaining about, or any previous complaint reference? Your declaration I confirm that I want to make a complaint regarding the levels of commission associated with the sale of my Payment Protection Insurance or Card Repayment Protection and not the mis-sale of the PPI policy. You name: Signature: Date: Page 6