PBA Claim Application Form

Step 1 of 4

Please be aware your details are used in the strictest confidence.
Title*
First Name*
Surname*
Maiden Name/Previous Name*
Your Date Of Birth*

Day
Month
Year
Address*
House Number & Street Name Address Line 2 City ZIP / Postal Code
Home Telephone Number

Your number will not be passed to third parties. It is only for contacting you with win notification/ case status etc.
Mobile Telephone Number*

Your number will not be passed to third parties. It is only for contacting you with win notification/ case status etc.
Email
Enter Email Confirm Email
Where did you hear about us?
Please specify where

Have you been declared bankrupt or have you had an IVA over the past 25 years?
- Yes
- No
We are sorry, but due to these circumstances we would not be able to process a claim.
Which Bank/Building Society sold you the packaged bank account over the Past 25 Years?*
- HSBC
- Halifax
- Lloyds/TSB
- Natwest
- Royal Bank of Scotland
- Alliance and Leicester
- Barclays
- Bank Of Scotland
- Santander
- Co Op Bank
- Clydesdale Bank
- Yorkshire Bank
- Secure Trust
- Think Money
- Other
We are sorry, but we would not be able to claim back the management fee on your account as this is not a claimable package bank account.
Please Specify Name of Bank/Lender*
Were you advised that the HSBC packaged bank account was necessary in order to*
- Open an account (no free bank account choice offered)
- Obtain an overdraft facility
- Increase my ability to get better credit
- Made to feel privileged to be offered the upgrade
- Other
Please Specify*
How long have you had the HSBC packaged bank/building society account*
- 1-2 Years
- 3-4 Years
- 5-6 Years
- 7-8 Years
- 9-10 Years
- 10 Years +
Please Specify
Roughly how much were you charged by HSBC per month?*
- £10.00 to £15.00
- £15.00 to £20.00
- £20.00 to £25.00
- £25.00 or more
At the point of sale, did HSBC give you a Welcome Pack that detailed the Terms & Conditions of the Packaged Account?*
- Yes
- No
At the point of sale, did the HSBC advisor check to see if you were eligible to use all of the insurance products offered?*
- Yes
- No
At the time you opened or upgraded to the HSBC package bank account, did you already have any of the following insurance products?
- Car Breakdown Cover
- Accidental Death Cover
- Gadget Insurance
- Mobile Phone Insurance
- Life Assurance
- Travel Insurance
- Identity Theft Protection
- Home insurance with gadget/technology cover
- None of the above
At or just before the point of sale of the HSBC package account, were you receiving any of the following state benefits?*
- Income support
- Disability allowance
- Job seekers allowance
- Debt management support
- None of the above
At the time you opened the HSBC Packaged Account, did you own or drive a car in the UK?*
- Yes
- No
At the time you opened the HSBC Packaged Account, what type of phone did you own?*
Were you advised that the Halifax packaged bank account was necessary in order to*
- Open an account (no free bank account choice offered)
- Obtain an overdraft facility
- Increase my ability to get better credit
- Made to feel privileged to be offered the upgrade
- Other
Please Specify*
How long have you had the Halifax packaged bank/building society account*
- 1-2 Years
- 3-4 Years
- 5-6 Years
- 7-8 Years
- 9-10 Years
- 10 Years +
Please Specify*
Roughly how much were you charged by Halifax per month?*
- £10.00 to £15.00
- £15.00 to £20.00
- £20.00 to £25.00
- £25.00 or more
At the point of sale, did Halifax give you a Welcome Pack that detailed the Terms & Conditions of the Packaged Account?*
- Yes
- No
At the point of sale, did the Halifax advisor check to see if you were eligible to use all of the insurance products offered?*
- Yes
- No
At the time you opened or upgraded to the Halifax package bank account, did you already have any of the following insurance products?
- Car Breakdown Cover
- Accidental Death Cover
- Gadget Insurance
- Mobile Phone Insurance
- Life Assurance
- Travel Insurance
- Identity Theft Protection
- Home insurance with gadget/technology cover
- None of the above
At or just before the point of sale of the Halifax package account, were you receiving any of the following state benefits?*
- Income support
- Disability allowance
- Job seekers allowance
- Debt management support
- None of the above
At the time you opened the Halifax Packaged Account, did you own or drive a car in the UK?*
- Yes
- No
At the time you opened the Halifax Packaged Account, what type of phone did you own?*
Were you advised that the Lloyds TSB packaged bank account was necessary in order to*
- Open an account (no free bank account choice offered)
- Obtain an overdraft facility
- Increase my ability to get better credit
- Made to feel privileged to be offered the upgrade
- Other
Please Specify*
How long have you had the Lloyds TSB packaged bank/building society account*
- 1-2 Years
- 3-4 Years
- 5-6 Years
- 7-8 Years
- 9-10 Years
- 10 Years +
Please Specify*
Roughly how much were you charged by Lloyds TSB per month?*
- £10.00 to £15.00
- £15.00 to £20.00
- £20.00 to £25.00
- £25.00 or more
At the point of sale, did Lloyds TSB give you a Welcome Pack that detailed the Terms & Conditions of the Packaged Account?*
- Yes
- No
At the point of sale, did the Lloyds TSB advisor check to see if you were eligible to use all of the insurance products offered?*
- Yes
- No
At the time you opened or upgraded to the Lloyds TSB package bank account, did you already have any of the following insurance products?
- Car Breakdown Cover
- Accidental Death Cover
- Gadget Insurance
- Mobile Phone Insurance
- Life Assurance
- Travel Insurance
- Identity Theft Protection
- Home insurance with gadget/technology cover
- None of the above
At or just before the point of sale of the Lloyds TSB package account, were you receiving any of the following state benefits?*
- Income support
- Disability allowance
- Job seekers allowance
- Debt management support
- None of the above
At the time you opened the Lloyds TSB Packaged Account, did you own or drive a car in the UK?*
- Yes
- No
At the time you opened the Lloyds TSB Packaged Account, what type of phone did you own?*
Were you advised that the Natwest packaged bank account was necessary in order to*
- Open an account (no free bank account choice offered)
- Obtain an overdraft facility
- Increase my ability to get better credit
- Made to feel privileged to be offered the upgrade
- Other
Please Specify*
How long have you had the Natwest packaged bank/building society account*
- 1-2 Years
- 3-4 Years
- 5-6 Years
- 7-8 Years
- 9-10 Years
- 10 Years +
Please Specify*
Roughly how much were you charged by Natwest per month?*
- £10.00 to £15.00
- £15.00 to £20.00
- £20.00 to £25.00
- £25.00 or more
At the point of sale, did Natwest give you a Welcome Pack that detailed the Terms & Conditions of the Packaged Account?*
- Yes
- No
At the point of sale, did the Natwest advisor check to see if you were eligible to use all of the insurance products offered?*
- Yes
- No
At the time you opened or upgraded to the Natwest package bank account, did you already have any of the following insurance products?
- Car Breakdown Cover
- Accidental Death Cover
- Gadget Insurance
- Mobile Phone Insurance
- Life Assurance
- Travel Insurance
- Identity Theft Protection
- Home insurance with gadget/technology cover
- None of the above
At or just before the point of sale of the Natwest package account, were you receiving any of the following state benefits?*
- Income support
- Disability allowance
- Job seekers allowance
- Debt management support
- None of the above
At the time you opened the Natwest Packaged Account, did you own or drive a car in the UK?*
- Yes
- No
At the time you opened the Natwest Packaged Account, what type of phone did you own?*
Were you advised that the Royal Bank Of Scotland packaged bank account was necessary in order to*
- Open an account (no free bank account choice offered)
- Obtain an overdraft facility
- Increase my ability to get better credit
- Made to feel privileged to be offered the upgrade
- Other
Please Specify*
How long have you had the Royal Bank Of Scotland packaged bank/building society account*
- 1-2 Years
- 3-4 Years
- 5-6 Years
- 7-8 Years
- 9-10 Years
- 10 Years +
Please Specify*
Roughly how much were you charged by Royal Bank Of Scotland per month?*
- £10.00 to £15.00
- £15.00 to £20.00
- £20.00 to £25.00
- £25.00 or more
At the point of sale, did Royal Bank Of Scotland give you a Welcome Pack that detailed the Terms & Conditions of the Packaged Account?*
- Yes
- No
At the point of sale, did the Royal Bank Of Scotland advisor check to see if you were eligible to use all of the insurance products offered?*
- Yes
- No
At the time you opened or upgraded to the Royal Bank Of Scotland package bank account, did you already have any of the following insurance products?
- Car Breakdown Cover
- Accidental Death Cover
- Gadget Insurance
- Mobile Phone Insurance
- Life Assurance
- Travel Insurance
- Identity Theft Protection
- Home insurance with gadget/technology cover
- None of the above
At or just before the point of sale of the Royal Bank Of Scotland package account, were you receiving any of the following state benefits?*
- Income support
- Disability allowance
- Job seekers allowance
- Debt management support
- None of the above
At the time you opened the Royal Bank Of Scotland Packaged Account, did you own or drive a car in the UK?*
- Yes
- No
At the time you opened the Royal Bank Of Scotland Packaged Account, what type of phone did you own?*
Were you advised that the Alliance and Leicester packaged bank account was necessary in order to*
- Open an account (no free bank account choice offered)
- Obtain an overdraft facility
- Increase my ability to get better credit
- Made to feel privileged to be offered the upgrade
- Other
Please Specify*
How long have you had the Alliance and Leicester packaged bank/building society account*
- 1-2 Years
- 3-4 Years
- 5-6 Years
- 7-8 Years
- 9-10 Years
- 10 Years +
Please Specify*
Roughly how much were you charged by Alliance and Leicester per month?*
- £10.00 to £15.00
- £15.00 to £20.00
- £20.00 to £25.00
- £25.00 or more
At the point of sale, did Alliance and Leicester give you a Welcome Pack that detailed the Terms & Conditions of the Packaged Account?*
- Yes
- No
At the point of sale, did the Alliance and Leciester advisor check to see if you were eligible to use all of the insurance products offered?*
- Yes
- No
At the time you opened or upgraded to the Alliance & Leicester package bank account, did you already have any of the following insurance products?
- Car Breakdown Cover
- Accidental Death Cover
- Gadget Insurance
- Mobile Phone Insurance
- Life Assurance
- Travel Insurance
- Identity Theft Protection
- Home insurance with gadget/technology cover
- None of the above
At or just before the point of sale of the Alliance and Leicester package account, were you receiving any of the following state benefits?*
- Income support
- Disability allowance
- Job seekers allowance
- Debt management support
- None of the above
At the time you opened the Alliance and Leicester Packaged Account, did you own or drive a car in the UK?*
- Yes
- No
At the time you opened the Alliance & Leicester Packaged Account, what type of phone did you own?*
Were you advised that the Barclays packaged bank account was necessary in order to*
- Open an account (no free bank account choice offered)
- Obtain an overdraft facility
- Increase my ability to get better credit
- Made to feel privileged to be offered the upgrade
- Other
Please Specify*
How long have you had the Barclays packaged bank/building society account*
- 1-2 Years
- 3-4 Years
- 5-6 Years
- 7-8 Years
- 9-10 Years
- 10 Years +
Please Specify*
Roughly how much were you charged by Barclays per month?*
- £10.00 to £15.00
- £15.00 to £20.00
- £20.00 to £25.00
- £25.00 or more
At the point of sale, did Barclays give you a Welcome Pack that detailed the Terms & Conditions of the Packaged Account?*
- Yes
- No
At the point of sale, did the Barclays advisor check to see if you were eligible to use all of the insurance products offered?*
- Yes
- No
At the time you opened or upgraded to the Barclays package bank account, did you already have any of the following insurance products?
- Car Breakdown Cover
- Accidental Death Cover
- Gadget Insurance
- Mobile Phone Insurance
- Life Assurance
- Travel Insurance
- Identity Theft Protection
- Home insurance with gadget/technology cover
- None of the above
At or just before the point of sale of the Barclays package account, were you receiving any of the following state benefits?*
- Income support
- Disability allowance
- Job seekers allowance
- Debt management support
- None of the above
At the time you opened the Barclays Packaged Account, did you own or drive a car in the UK?*
- Yes
- No
At the time you opened the Barclays Packaged Account, what type of phone did you own?*
Were you advised that the Bank Of Scotland packaged bank account was necessary in order to*
- Open an account (no free bank account choice offered)
- Obtain an overdraft facility
- Increase my ability to get better credit
- Made to feel privileged to be offered the upgrade
- Other
Please Specify*
How long have you had the Bank Of Scotland packaged bank/building society account*
- 1-2 Years
- 3-4 Years
- 5-6 Years
- 7-8 Years
- 9-10 Years
- 10 Years +
Please Specify*
Roughly how much were you charged by Bank Of Scotland per month?*
- £10.00 to £15.00
- £15.00 to £20.00
- £20.00 to £25.00
- £25.00 or more
At the point of sale, did Bank Of Scotland give you a Welcome Pack that detailed the Terms & Conditions of the Packaged Account?*
- Yes
- No
At the point of sale, did the Bank Of Scotland advisor check to see if you were eligible to use all of the insurance products offered?*
- Yes
- No
At the time you opened or upgraded to the Bank Of Scotland package bank account, did you already have any of the following insurance products?
- Car Breakdown Cover
- Accidental Death Cover
- Gadget Insurance
- Mobile Phone Insurance
- Life Assurance
- Travel Insurance
- Identity Theft Protection
- Home insurance with gadget/technology cover
- None of the above
At or just before the point of sale of the Bank Of Scotland package account, were you receiving any of the following state benefits?*
- Income support
- Disability allowance
- Job seekers allowance
- Debt management support
- None of the above
At the time you opened the Bank Of Scotland Packaged Account, did you own or drive a car in the UK?*
- Yes
- No
At the time you opened the Bank Of Scotland Packaged Account, what type of phone did you own?*
Were you advised that the Santander packaged bank account was necessary in order to*
- Open an account (no free bank account choice offered)
- Obtain an overdraft facility
- Increase my ability to get better credit
- Made to feel privileged to be offered the upgrade
- Other
Please Specify*
How long have you had the Santander packaged bank/building society account*
- 1-2 Years
- 3-4 Years
- 5-6 Years
- 7-8 Years
- 9-10 Years
- 10 Years +
Please Specify*
Roughly how much were you charged by Santander per month?*
- £10.00 to £15.00
- £15.00 to £20.00
- £20.00 to £25.00
- £25.00 or more
At the point of sale, did Santander give you a Welcome Pack that detailed the Terms & Conditions of the Packaged Account?*
- Yes
- No
At the point of sale, did the Santander advisor check to see if you were eligible to use all of the insurance products offered?*
- Yes
- No
At the time you opened or upgraded to the Santander package bank account, did you already have any of the following insurance products?
- Car Breakdown Cover
- Accidental Death Cover
- Gadget Insurance
- Mobile Phone Insurance
- Life Assurance
- Travel Insurance
- Identity Theft Protection
- Home insurance with gadget/technology cover
- None of the above
At or just before the point of sale of the Santander package account, were you receiving any of the following state benefits?*
- Income support
- Disability allowance
- Job seekers allowance
- Debt management support
- None of the above
At the time you opened the Santander Packaged Account, did you own or drive a car in the UK?*
- Yes
- No
At the time you opened the Santander Packaged Account, what type of phone did you own?*
Were you advised that the Co-Op packaged bank account was necessary in order to*
- Open an account (no free bank account choice offered)
- Obtain an overdraft facility
- Increase my ability to get better credit
- Made to feel privileged to be offered the upgrade
- Other
Please Specify*
How long have you had the Co-Op packaged bank/building society account*
- 1-2 Years
- 3-4 Years
- 5-6 Years
- 7-8 Years
- 9-10 Years
- 10 Years +
Please Specify*
Roughly how much were you charged by Co-Op per month?*
- £10.00 to £15.00
- £15.00 to £20.00
- £20.00 to £25.00
- £25.00 or more
At the point of sale, did Co-Op give you a Welcome Pack that detailed the Terms & Conditions of the Packaged Account?*
- Yes
- No
At the point of sale, did the Co-Op advisor check to see if you were eligible to use all of the insurance products offered?*
- Yes
- No
At the time you opened or upgraded to the Co-Op package bank account, did you already have any of the following insurance products?
- Car Breakdown Cover
- Accidental Death Cover
- Gadget Insurance
- Mobile Phone Insurance
- Life Assurance
- Travel Insurance
- Identity Theft Protection
- Home insurance with gadget/technology cover
- None of the above
At or just before the point of sale of the Co-Op package account, were you receiving any of the following state benefits?*
- Income support
- Disability allowance
- Job seekers allowance
- Debt management support
- None of the above
At the time you opened the Co-Op Packaged Account, did you own or drive a car in the UK?*
- Yes
- No
At the time you opened the Co-Op Packaged Account, what type of phone did you own?*
Were you advised that the Yorkshire Bank packaged bank account was necessary in order to*
- Open an account (no free bank account choice offered)
- Obtain an overdraft facility
- Increase my ability to get better credit
- Made to feel privileged to be offered the upgrade
- Other
Please Specify*
How long have you had the Yorkshire Bank packaged bank/building society account*
- 1-2 Years
- 3-4 Years
- 5-6 Years
- 7-8 Years
- 9-10 Years
- 10 Years +
Please Specify
Roughly how much were you charged by your Yorkshire Bank per month?*
- £10.00 to £15.00
- £15.00 to £20.00
- £20.00 to £25.00
- £25.00 or more
At the point of sale, did Yorkshire Bank give you a Welcome Pack that detailed the Terms & Conditions of the Packaged Account?*
- Yes
- No
At the time you opened or upgraded to the Yorkshire Bank package bank account, did you already have any of the following insurance products?
- Car Breakdown Cover
- Accidental Death Cover
- Gadget Insurance
- Mobile Phone Insurance
- Life Assurance
- Travel Insurance
- Identity Theft Protection
- Home insurance with gadget/technology cover
- None of the above
At or just before the point of sale of the Yorkshire Bank package account, were you receiving any of the following state benefits?*
- Income support
- Disability allowance
- Job seekers allowance
- Debt management support
- None of the above
At the time you opened the Yorkshire Bank Packaged Account, did you own or drive a car in the UK?*
- Yes
- No
At the time you opened the Yorkshire Bank Packaged Account, what type of phone did you own?*
Were you advised that the Clydesdale Bank packaged bank account was necessary in order to*
- Open an account (no free bank account choice offered)
- Obtain an overdraft facility
- Increase my ability to get better credit
- Made to feel privileged to be offered the upgrade
- Other
Please Specify*
How long have you had the Clydesdale Bank packaged bank/building society account*
- 1-2 Years
- 3-4 Years
- 5-6 Years
- 7-8 Years
- 9-10 Years
- 10 Years +
Please Specify
Roughly how much were you charged by your Clydesdale Bank per month?*
- £10.00 to £15.00
- £15.00 to £20.00
- £20.00 to £25.00
- £25.00 or more
At the point of sale, did Clydesdale Bank give you a Welcome Pack that detailed the Terms & Conditions of the Packaged Account?*
- Yes
- No
At the time you opened or upgraded to the Clydesdale Bank package bank account, did you already have any of the following insurance products?
- Car Breakdown Cover
- Accidental Death Cover
- Gadget Insurance
- Mobile Phone Insurance
- Life Assurance
- Travel Insurance
- Identity Theft Protection
- Home insurance with gadget/technology cover
- None of the above
At or just before the point of sale of the Clydesdale Bank package account, were you receiving any of the following state benefits?*
- Income support
- Disability allowance
- Job seekers allowance
- Debt management support
- None of the above
At the time you opened the Clydesdale Bank Packaged Account, did you own or drive a car in the UK?*
- Yes
- No
At the time you opened the Clydesdale Bank Packaged Account, what type of phone did you own?*
Were you advised that the Other packaged bank account was necessary in order to*
- Open an account (no free bank account choice offered)
- Obtain an overdraft facility
- Increase my ability to get better credit
- Made to feel privileged to be offered the upgrade
- Other
Please Specify*
How long have you had the Other Specified Bank packaged bank/building society account*
- 1-2 Years
- 3-4 Years
- 5-6 Years
- 7-8 Years
- 9-10 Years
- 10 Years +
Please Specify
Roughly how much were you charged by your Other Specified Bank per month?*
- £10.00 to £15.00
- £15.00 to £20.00

PBA Claim Application Form

Step 1 of 4

We are sorry, but due to these circumstances we would not be able to process a claim.

We are sorry, but we would not be able to claim back the management fee on your account as this is not a claimable package bank account.