Complaints form Section 1 Is your complaint about PPI Yes No If your complaint is not about PPI, please continue to section 2 of the complaints form. Do you have new documentary information about your PPI complaint that has not previously been seen by the company you are complaining about? Yes No If you answer to this is no we may not be able to help you. Please see the Making a Complaint page for more information. Section 2 Which finance company are you complaining about ? (You can usually find the company name on the agreement you signed.) We can only deal with complaints against our members (link opens in a new window). We will let you know if we cannot help. By completing and submitting this on-line form I confirm that I would like you, FLA (Finance & Leasing Association), to refer my complaint (and any information received in the course of handling that complaint) to the finance company. I agree that you may have to collect information about my agreement and account and authorise the finance company concerned to give you the information you need. Yes No I agree with the above. Please note that the FLA is unable to deal with your complaint without your consent. Please answer the following questions as fully as possible. Title First Name Last Name Your Email Address Town County Postcode Telephone We may contact you on this number during office hours to discuss your case. What type of finance do you have with this company ? e.g. Personal loan, store card, credit card etc Account number You can usually find this on any letters you have received from the company. When did the advice, transaction or poor service that you are complaining about take place ? Please enter a date. Please provide a summary of what your complaint is about If your complaint is in connection with PPI, we can only consider it if you have new documentary evidence which has not previously been seen by the company you are complaining about. New Information: Please indicate what type of documentary information you have to support your complaint. Evidence of unemployment when the policy was taken out Yes No HMRC National Insurance contributions for the year the policy was taken out Yes No Spouse/partner HMRC National Insurance contributions for the year the policy was taken out Yes No Other similar information (please specify below) Details of additional documentary evidence: How would you like the finance company to put the matter right for you ? What steps has the finance company already taken to put the matter right ? Are you complaining on behalf of somebody else ?i.e. Did somebody else sign the agreement? Yes No Are you complaining on behalf of a business ? Yes No Have you complained to any other body/organisation about this matter ? Yes No Have there been any court proceedings relating to your agreement - or are any court proceedings planned ? Yes No If your answer to any of the above questions is 'yes' - please provide further details How did you hear about FLA's complaint scheme ? Please note, we may require further information from you before we are able to deal with your complaint. If you need to contact the FLA, please email us at email@example.com. We may use e-mail, telephone and post to contact you. We will send you a copy of the details you have sent to us when we acknowledge receipt of your complaint.