Update Missing Information

Update your missing information to proceed with your potential finance claim.

You will have already entered one of your cars into the PCP Refunds system, however, because we can't attribute that data to your address and contact information, you will need to enter it in again, along side the new information we require to make a claim.

Step 1 of 5 - Car Information

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Date of Submission

Unique Form ID

Reference Number - Base

First, tell us about your car and finance lender

Your Car Registration Number(Required)

Enter in your car registration number. We'll use this to look up your vehicle details.

Your Car Make(Required)

Your Car Model(Required)

Your Car Year(Required)

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Fuel Type 1

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Car Colour 1

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Wheelplan / Body Description 1

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Engine Size 1

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Raw API Response 1

Select Your Car Finance Lender(Required)

Name of the Car Dealership (if known)

Correct Car Information(Required)

The above car information looks correct.

Would you like to add a second car?(Required)

Yes

Ok, same again, please tell us about your car and finance lender

Car #2 Registration Number(Required)

Enter in your car registration number. We'll use this to look up your vehicle details.

Car #2 Make(Required)

Car #2 Model(Required)

Car #2 Year(Required)

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Fuel Type 2

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Car Colour 2

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Wheelplan / Body Description 2

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Engine Size 2

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Raw API Response 2

Select Your Car #2 Finance Lender(Required)

Name of the Car #2 Dealership (if known)

Correct Car #2 Information(Required)

The above car information looks correct.

Car #1: Questions about your car finance

Car 1: Was this vehicle’s finance taken between 2014-2020?(Required)

Yes

Car 1: Were you aware that the car dealership (or your loan broker) received commission for arranging the finance to purchase this car?(Required)

Yes

Car 1: Were you provided with documentation that contained information about the commission the car dealership (or your loan broker) would receive?(Required)

Yes

Car 1: Did you trust the car dealership (or your loan broker) to find the best finance deal for you?(Required)

Yes

Car 1: Have you recently submitted a diesel claim or have you already had a successful diesel claim for this vehicle?(Required)

Yes

Car #2: Questions about your car finance

Car 2: Was this vehicle’s finance taken between 2014-2020?(Required)

Yes

Car 2: Were you aware that the car dealership (or your loan broker) received commission for arranging the finance to purchase this car?(Required)

Yes

Car 2: Were you provided with documentation that contained information about the commission the car dealership (or your loan broker) would receive?(Required)

Yes

Car 2: Did you trust the car dealership (or your loan broker) to find the best finance deal for you?(Required)

Yes

Car 2: Have you recently submitted a diesel claim or have you already had a successful diesel claim for this vehicle?(Required)

Yes

We don't think you'll qualify

Based on the answers you've given, we don't think you qualify to make a claim.

Now some details about you

Please be accurate as we can't check if you enter in false information.

Your Current Address(Required)

Street Address Address Line 2 City Post Code

Your Name(Required)

Prefix First Middle Last

Your Previous Name (if any)

If you had a previous name, please enter it in full here, otherwise just move on.

Your Email Address(Required)

Please enter a valid email.

Home Phone Number

Your Mobile Number(Required)

Date of Birth(Required)

DD slash MM slash YYYY

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Full Name at Address

Qualifying Questions

Please answer the following questions to the best of your knowledge.

Are you or have you been in an IVA or been declared bankrupt now or in the past or in any other debt management situation?(Required)

Yes

Did you have a different home address at time of your policy?(Required)

No, my address hasn't changed

Yes, I had a different address

Your home address at the time of the policy

Street Address Address Line 2 City ZIP / Postal Code

Nearly done, now just agree and sign

We need you to check the following boxes to allow us to check on your behalf.

Correct Information(Required)

I am aware that any misleading information provided in the Questionnaire may mean that I am liable for costs

Damages Based Agreement(Required)

I agree to digitally sign the Damages Based Agreement

Letter of Engagement(Required)

I agree to digitally sign the Letter of Engagement

Letter of Authority(Required)

I agree to digitally sign the Letter of Authority

Legal Consent(Required)

Consumer Disclosure Regarding Conducting Business Electronically, Signing Documents Electronically, and Receiving Electronic Notices and Disclosures

Please read the information below, carefully, as it concerns your rights. eSignatures are an efficient way to execute an agreement with the same legal force and effect of a handwritten or “wet ink” signature. By signing this document you are agreeing that you have reviewed this Consumer Disclosure and consent and intend to transact business electronically; to use electronic signatures instead of wet ink signatures and paper documents, and to receive notices and disclosures electronically.

You are not required to sign documents electronically or to receive notices and disclosures electronically. If you prefer not to transact business electronically, you may request paper copies from the “sending party” and withdraw your consent at any time, as described below.

Scope of Consent
By utilizing this Service, you agree to receive electronic signature documents with all related and identified documents, notices, and disclosures provided during your relationship with the “sending party.” You may withdraw your consent, at any time, by following the procedures outlined below.

Paper Copies
You are not required to sign documents electronically, or receive notices or disclosures electronically, and may request paper copies of documents or disclosures, if you prefer. You also have the ability to download and print any signed or unsigned documents sent to you through the electronic signature service. We may also email you a copy of all documents you sign using the electronic signature service. If you wish to receive paper copies instead of electronic documents you may close this web browser and request paper copies from the “sending party” by following the procedures outlined below. The “sending party” may apply a charge for additional expenses incurred by printing and mailing paper copies.

Withdrawal of Consent
You may withdraw your consent to receive electronic documents, notices or disclosures at any time. In order to withdraw consent you must notify the “sending party” that you wish to withdraw your consent to transact business electronically and to provide your future documents, notices, and disclosures in paper format. If at any time, after withdrawing your consent you choose to use our electronic signature system your use of this Service will, once again, evidence your consent to receive documents, notices, and disclosures, electronically. You may withdraw your consent to receive electronic notices and disclosures or execute an electronic signature by following the procedures described below.

Withdrawing your consent, requesting a paper copy, or updating your contact information
You always have the ability to download and print any documents sent to you through our electronic signature system. To withdraw your consent to conduct business electronically, sign documents electronically, and receive documents, notices, or disclosures electronically, please contact the “sending party” directly; by telephone, by email (sent to the “sending party” with any of the topics outlined below stated in the subject line of your email) or by postal mail to their mailing address specified to receive such notices.

“Withdrawal of Consent To Transact Business Electronically” To allow the “sending party” to identify and facilitate your withdrawal of consent to transact business electronically, please provide your name, email address, the date on which you are withdrawing your consent, your telephone number and mailing address.

“Requesting A Paper Copy” To allow the “sending party” to identify you to provide a paper copy of the document requiring your signature, the notice, or disclosure, please provide the sending party with your name, email address, mailing address, telephone number, and name of the document of which you are requesting a paper copy .

“Update Your Contact Information” To allow the “sending party” to identify you in order to update your contact information, please provide them with your name, email address, mailing address, and telephone number.

The “sending party” will inform you of any fees related to costs for printing and mailing paper copies or your withdrawal consent to transact business electronically.

I agree to the terms and conditions.

View the PDF version of this form here.

Your Signature(Required)

This is used to digitally sign the PDF linked above and agree to place all your provided information into it so we can process your claim.

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