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1635-2175/AA/CD12
If your complaint is about the sale of payment protection insurance (PPI), you will also need to complete a separate questionnaire.
▪ You may have done this already – if you have already complained directly to the business you think is responsible.
▪ If not, you can download the consumer questionnaire off our website – or phone us for a copy on 0300 123 9 123.

time limits may apply to your complaint so we need to know these dates day month year

▪ When did the advice, service or transaction you’re complaining about take place?

▪ When did you first complain to the business you think is responsible?
▪
The business has eight weeks from this date to send you its final written answer – before we can investigate the complaint.

just a few more questions
▪ Has the business you’re complaining about sent you its final written answer? YES NO
Please enclose a copy of the last letter that the business sent you.

▪ Has there been any court action relating to your complaint (or is any planned)? *YES NO
* If YES, please enclose copies of relevant paperwork.

▪ How do you want the business to put things right for you?

accessibility and practical needs
Do you have any practical needs where we could help – by making adjustments like *YES NO
using large print, Braille or a different language? * If YES, please tell us how we can help you.

finally, please read and sign this declaration

▪ I’d like the Financial Ombudsman Service to look into my complaint. To the best of my
“ knowledge, all the information I’ve given you is accurate.
▪ I understand that you usually resolve complaints by phone, letter and email.
▪ I understand that you will need some personal details about me, that you might need to
share information I give you – including sensitive or personal information – with the
business involved and other relevant organisations, and that you might need to ask them
for information that’s relevant to my case.
▪ I understand that you have a duty to publish your ombudsmen’s final decisions on your
website – with consumers’ details removed – but that most cases can be resolved before
they reach an ombudsman.
▪ I understand that to help you provide the best possible service, you (or a trusted third party)
might ask me about my experience. And though you sometimes publish anonymous ”
examples of the cases you look at, you’ll always keep my information confidential.

_________________________ __________ __________________________ __________
signature date signature date

▪ You need to sign, even if someone else is complaining on your behalf. This shows you have given
them your permission to complain for you.
▪ For complaints involving accounts or policies held jointly, each person needs to sign.
▪ If you’re signing on behalf of a business, please give your job title.

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