Barclays Payment Protection Insurance (PPI) Check Request Form

Confidential

Barclays Payment

Protection Insurance (PPI)

Check Request Form

You can use this form to submit a PPI check request to us. This will allow us to review all products that we find in

your name (whether open or closed) to see if you currently have or have ever held PPI through Barclays. Making sure

you always keep your details up to date will help us in resolving future queries.

Please provide as much detail as possible.

Your details

Title First name Middle name(s) Last name

Date of birth

D D

M M

Y Y Y Y

Your address*

Postcode/Zip Code/

Country Code

* If you’ve moved address since the time the policy was taken out, and you have an open account with us, please ensure you update your address on our

systems. Otherwise, we may need to verify your identity using information from a credit reference agency, which may involve credit reference agencies

checking the details supplied against any particulars on any database (public or otherwise) to which they have access. They may also use your details in the

future to assist other companies for verification purposes. This will allow us to complete our investigation and write to you with the outcome. This search is

only visible to you, and will have no affect on your credit rating or ability to obtain future credit. This search is automatically removed after 12 months.

Your Contact Information

We may need to get in touch with you by phone, text, email, or by post. Please provide your contact details below.

This information is for this form only. If you bank with us and need to update your details, you can do so in Online Banking

or in branch.

Main phone number Alternate phone number

Email address

Your PPI Results

Your PPI results will be sent to you via a letter to your address indicated above.

We’ll respond in writing and may need to contact you about this form.

Do you have any special contact instructions? Yes No

Please tick here if you need written responses in

Audio CD Braille Large Print

If you feel you need additional support or our process needs adapting to suit any particular needs you may have,

please tell us here.

For Bank Use Only

Our Reference Number

Your Account Number

Thank you for supplying your email address. By doing so, you confirm that we can email you about this form. Complaint responses may contain

information such as transaction details as well as any general details in response to your form.

By providing your email address, you confirm and accept that any emails sent by us to you won’t be sent in a secured or encrypted format. The Barclays

Group accepts no liability for any damage, loss or disclosure caused by any virus transmitted by this email. E-mail transmission cannot be guaranteed to

be secure or error-free as information could be intercepted, corrupted, lost, destroyed, arrive late or incomplete, or contain viruses. Please be aware that if

you are sharing a mail account or using a company mailbox, your email could be read by a third party.

Confidential

Declaration

Thank you for completing this form. So we can review your products, please tick the boxes and sign to agree to

the following:

I confirm I would like to check if I have (or have had) any PPI policies attached to past or present Barclays products.

If my details have changed, I consent to an identity check using a credit reference agency, as described in the

‘Your address’ section.

If I’ve included an email address and provided consent, I allow Barclays to contact me and keep me updated on the

progress of my query. I have read, understood and accept the risk associated with the use of email, as outlined.

Where I have provided an email address for someone else, I confirm they are aware of the security risk involved and

agree to be contacted via email.

I consent to Barclays’ use of my information in the manner described in this form and our Terms and Conditions for

Retail Customers and, to the extent I have provided information relating to others, I confirm that I have their consent

– or are otherwise entitled to provide the information to Barclays, to be used in the manner described.

Your signature

Date

D D

M M

Y Y Y Y

Please return this completed form directly to us either using the pre-paid envelope if supplied or to the address below:

FREEPOST BARCLAYS PPI COMPLAINTS

What happens next?

In most cases, we’ll write to you with the outcome of our investigation within 6 working days. Sometimes we might need a

little longer. Please allow plenty of time for your letter to arrive. We’ll let you know if we need more information.

The Barclays Group use and retain details you give about yourself – and others – to investigate and resolve your query or

complaint, for research or analysis and to prevent fraud. These details which may include health and conviction information

will be shared with insurers, agents and fraud prevention agencies for these purposes. If we transfer data to an overseas

organisation, we will ensure they apply the same level of protection as we are required to apply. Your details will be retained

for as long as needed for legal, regulatory and legitimate business purposes.

Barclays Bank PLC. Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority (Financial Services

Register No. 122702). Registered in England. Registered No. 1026167. Registered Office: 1 Churchill Place, London E14 5HP.

Item Ref: IBIM6692. March 2017.