Start Your SIPP/Investment Claim

Name

Address

Mobile No.

Telephone No.

Email

Date of Birth

National Insurance Number

Name of financial advisor: company or individual

Address (if known)

Email Address (if known)

Date of first contact

Are they still trading? Are they still trading? YES NO

What type of investment have you invested in? What type of investment have you invested in? Residential/Commercial Property Overseas Development Ethical Forestry Carbon Credits Other

If Other please provide details

How was your investment funded? How was your investment funded? Cash Re-mortgage Loan SIPP (if checked please provide details below) Other

Other (please provide details)

How much did you invest?

What date did you make the investment?

Pension Provider Name

Pension Provider Address

Your account/policy number

Amount Transferred

Have you instructed another firm of solicitors or claim management company to act on your behalf Have you instructed another firm of solicitors or claim management company to act on your behalf YES NO

Have you already tried to or are you in the process of making a claim to the Financial Services Compensation Scheme or Financial Ombudsman Service (if YES please provide any correspondence in relation to the claim) Have you already tried to or are you in the process of making a claim to the Financial Services Compensation Scheme or Financial Ombudsman Service (if YES please provide any correspondence in relation to the claim) YES NO