NatWest - NWB PPI Offer Acceptance form - PPI Offer Acceptance form

PPI Offer Acceptance form

PPI Offer Acceptance form This is stage 1 of 2. Required fields are indicated with an asterisk (*). Please do not use your browser's 'back' button to move back or you may lose some of the information you have already entered.
WHAT IS THIS QUESTIONNAIRE FOR? This questionnaire is for customers to accept the Payment Protection Insurance (PPI) complaint offer. WHAT DO I NEED TO DO? Please fill in this questionnaire, giving as much information as you can. If you need any assistance in completing this form, please call us on 0800 015 0319.
Are you completing this form on behalf of ?�*	� Yourself � Deceased customer
Deceased Customer* Full Name
Your name and contact details
Please enter your details below rather than those of the deceased.
Please note: for joint policies, a separate form should be completed for each named party.
Our Reference�* (From Offer Letter)
Title�*
First name(s)�*
Surname�*
Date of birth�* DD/MM/YYYY
Address - Line 1�*
Address - Line 2
Address - Line 3
Address - Line 4
Postcode�*
Daytime Contact No (Mobile /Landline)
Evening Telephone (Mobile /Landline)
Email
PPI Offer Amount Please enter the net offer amount. This can be found in the our offer section in our letter.
Net Offer Amount (GBP)
Your Payment Bank Account Details Please enter the details of the account you would like us to credit. The account name must match the name on your PPI Complaint. Payments can only be made to valid UK bank accounts. If these fields are left blank, payment will be made via an alternative method.
Do you want an electronic payment?�*	� Yes�� No�
Payee Name
Sort Code
Account Number
Account Type	� Personal � Business
Please note that every effort will be made to credit the account you have specified however where this is not possible, payment will be made via an alternative method.
Indemnity I understand that once the offer has been calculated, the Bank will use this to repay any outstanding amounts owed by the deceased customer to the Bank. The remaining balance, if any, will then be paid to me. I am aware that it is possible for a debit balance to remain on the account if the offer is not sufficient to clear in full the outstanding amounts owing in which case no payment will be made. I understand that the Bank will rely on the information I have given/statements I have made in this agreement in releasing and making the payment. I agree that if, after the date of agreement, the Bank receives a valid claim for the Payment, which invalidates my claim, I will repay the Bank forthwith on the Bank's request. I also agree to reimburse the Bank for any reasonable losses, expenses and/or other costs incurred by the Bank as a result of the Bank releasing the Payment on my instruction. If I live in Scotland, Scots law applies to this agreement. If I live anywhere else English law applies to this agreement. If there's a dispute between us, the Bank can take legal action against me in any UK court.
I have read and agree to the above*
Declaration and Acceptance I wish to accept the Bank�s net offer, as set out in the Offer Letter, in full and final settlement of all or any claims I might have against the Bank, or any subsidiary companies in respect of my PPI policy. I understand any statutory interest payable will be recalculated up to a maximum of 28 days from the date of the Offer Letter. I understand that if the Payment Protection Insurance Policy is still active, this will be cancelled once my acceptance has been processed. This does not apply if the customer is deceased, because the policy will have already been cancelled. I understand that, if the deceased was subject to an Individual Voluntary Arrangement (IVA), Protected Trust Deed, Bankruptcy or Sequestration, at the time of death, any payment will be made to the relevant account the deceased held with the Bank. Any disbursements due under the terms of the arrangement will then be managed by the Bank�s insolvency team. I understand that consent is granted to NatWest Holdings Limited or any subsidiary companies to request information about myself and my business and the proprietors of that business from credit reference agencies, to help verify my identity.
I have read and agree to the above Declaration and Acceptance*
Declaration and Acceptance I wish to accept the Bank�s net offer, as set out in the Offer Letter, in full and final settlement of all or any claims I might have against the Bank, or any subsidiary companies in respect of my PPI policy. I understand any statutory interest payable will be recalculated up to a maximum of 28 days from the date of the Offer Letter. I understand that if the Payment Protection Insurance Policy is still active, this will be cancelled once my acceptance has been processed and I will no longer be eligible for the cover provided by the policy. I understand that if I am, or have been, subject to an Individual Voluntary Arrangement (IVA), Protected Trust Deed, Bankruptcy or Sequestration, any payment will be made to the relevant account I hold with you. Any disbursements due under the terms of the arrangement will then be managed by the Bank�s Insolvency Team. I understand that the offer will take into consideration any arrears on my account. The remaining balance, if any, will be credited to my nominated account. I am aware that it is possible for the account to remain in arrears if the offer is not sufficient to clear the full amount owing on my account. I understand that consent is granted to NatWest Holdings Limited or any subsidiary companies to request information about myself and my business and the proprietors of that business from credit reference agencies, to help verify my identity.
I have read and agree to the above Declaration and Acceptance*
�
�