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Name:

Email:

Date of Birth:

Postcode:

Please Select the Bank or Society the account was / is with: (Please Select)BarclaysHalifaxLloydsMarks & SpencerNationwide Building SocietyNatwest / Royal Bank of Scotland / Ulster BankHSBC BankThe Co-Operative BankYorkshire / Clydesdale BankFirst DirectOther / Not Known

[group barclays]

Thank you, now please select the type of account you have / had:Barclays Bank Account (Free)Premier Current Account (Free)Current Account Plus (£6.50)First Additions (£6.50)Graduate Additions (£7.50)Tech Pack (£9.50 recently increased from £7.50)Additions (£13.50)Additions Active (£15)Additions Plus (£16)Premier Life 25 (£25)Other / Not Known

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[group halifax]

Thank you, now please select the type of account you have / had:Classic Account (Free)Reward Current Account (Free)Ultimate Reward Current Account (£10-£15)Other / Not Known

[/group]
[group lloyds]

Thank you, now please select the type of account you have / had:Classic Account (Free)Select Added Value Account (£8.95)Silver Added Value Account (£9.95)Gold Added Value Account (£12.95)Platinum Added Value Account (£17.00)Premier Added Value Account (£25)Other / Not Known

[/group]
[group marks]

Thank you, now please select the type of account you have / had:M&S Current Account (Free)M&S Premium Current Account (£10)Premier Account (£20)Other / Not Known

[/group]
[group nation]

Thank you, now please select the type of account you have / had:Flex Account (Free)FlexDirect Account(Free)FlexBasic (Free)FlexPlus Account (£13.00Other / Not Known

[/group]
[group natwest]

Thank you, now please select the type of account you have / had:Select Current Account (Free)Ufirst Gold Account (£10)Silver Account (£12)Advantages / Royalties Gold Account (£15)Platinum Account (£16)Ufirst Private Account (£26)Black Account (£28)Other / Not Known

[/group]
[group hsbc]

Thank you, now please select the type of account you have / had:HSBC Advance Current Account (Free)Basic Bank Account (Free)HSBC Passport Account (£8)Bank Account Pay Monthly (£10)Other / Not Known

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[group coop]

Thank you, now please select the type of account you have / had:Current Account (Free)Privilege Account (£11)Everyday Extra Current Account (£15)Privilege Premier Account (£15.50)Smilemore Account (£15.50)Other / Not Known

[/group]
[group york]

Thank you, now please select the type of account you have / had:B Current Account (Free)Current Account Plus (Free)Signature Current Account (£13.50)Other / Not Known

[/group]
[group first]

Thank you, now please select the type of account you have / had:Current Account (Free)First Directory (£15)Other / Not Known

[/group]

Other (if other account or bank selected):

Account Number (if known):

How was the packaged account opened / upgraded?
during a meetingover the phoneover the internetby posti filled in a leafletover the counteri can't rememberother (please explain in detail below)

When do think you opened or upgraded to the package bank account?
[datetime when date-format:mm/yyyy]

Did the bank give you advice and/or recommend the account to you?
yes (please explain in detail below)noi can't remember

Prior to the packaged account being opened / upgraded had you ever had a fee free bank account?
yesno

Did you take out any other products with the bank at the same time the account was opened / upgraded? (for example, a loan, mortgage, credit card, savings account)?
yes (please explain in detail below what products you opened)no

Have you registered for any of the products provided by your packaged account?
yes (please provide details below)no

At the time the packaged account was opened / upgraded did you have another packaged account?
yes (please provide details below)no

At the time the packaged account was opened / upgraded did you own a mobile phone?
yesno

If you owned a mobile phone was it a "smart phone" (ie with internet access)?
yesno

At the time the packaged account was opened / upgraded did you hold a full UK driving licence?
yesno

If you had a full UK driving licence, did you own a vehicle?
yesno

Have you ever attempted to make a claim on any of the insurance products included with the packaged account?
yes (please explain in detail below about any claims attempted)no

Have you ever used any of the 'benefits' of the packaged account, such as preferential overdraft / savings / loan rates, monthly film subscription or anything else?
yes (please explain in detail below about any benefits used)nodon't know

At the time the packaged account was opened / upgraded were you registered with a UK doctor?
yesno

Did you have any medical conditions at the time the packaged account was opened / upgraded?
yes (please provide details below)no

At the time the packaged account was opened / upgraded, or shortly afterwards, was your main address outside the UK?
yesno

What is the current situation with your account?
i'm still paying the monthly fee (please explain in detail below why you are still paying)i closed / downgraded the account

Did you notice the account fees on your statement?
yes (please explain in detail below when you noticed the fees and what you thought they were for)no

If there is anything else you would like to tell us about the packaged account, how it was opened / upgraded, or anything you feel is relevant as to how it may have been mis-sold to you please explain below in as much detail as possible