Step 1: Personal Details
Title Forename: Surname:
Email Address: Telephone Number:
Date Of Birth:
Step 2: Payday Loan History
Have you had more than 10 payday loans within the last 6 years?
Did you ever roll over on a weekly or monthly basis?
Were your loans ever increased in the amount borrowed? i.e. first Loan was £200, next loan of £300.
Was the loan a significant portion of your income?
Did you struggle to pay the loan back? (struggling includes not being able to pay other essential expenditure, or missing other loan payments)
Had you previously missed payments on any other loan or credit card, or any rent or mortgage payment, before you took out the payday loans?
Approximately how many different payday lenders have you borrowed from?
Payday Lender 1
Payday Lender:
Approximate amount of loans: Approximate amount borrowed:
Step 3: Address History
Please use the forms below to tell us about all of the addresses you've lived at in the last 6 years, and then scroll to the bottom to submit. Don't worry if you have more than four previous addresses, as we only need your most recent ones.
Postcode: Address:
Move in date:
Have you lived at any other addresses in the last 6 years?
Do you have any Legal Expense Protection either attached to any of your insurance policies (motor, household etc) or as a consequence of Trade Union membership which might provide you with cover for your legal costs in pursuing this claim?

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