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Your Details

Unique ID

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Referral Identifier

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Name(Required)

Prefix First Last

Date of Birth(Required)

Your Email Address(Required)

Your Mobile Number(Required)

Your Address

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House Name

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House Number

Your Current Full Address(Required)

Please start typing your address into Street Address and select your addresses from the dropdown box.

Street Address Address Line 2 City County Post Code

Did you live at a different address in the past 5 years?(Required)

Yes

No

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PreviousAddress House Name

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PreviousAddress House Number

Your Previous Address(Required)

Please start typing your address into Street Address and select your addresses from the dropdown box.

Street Address Address Line 2 City County Post Code

The final bit

Your Signature(Required)

I agree to the privacy policy of Conclusive Financial Ltd and authorise them to conduct soft credit searches on my behalf through their provider, Valid8 IP Ltd, with no impact on my credit score. I also agree to Valid8 IP’s privacy policy.
By signing this form I confirm that:

I have had a vehicle on finance since 2007.
I was not aware of a commission payment being made to the broker.
I have not instructed any other professional representative to pursue my claim.
I have read and agree to Benson Goldstein’s terms and conditions, form of authority and Privacy Policy.
I understand that I have the right to pursue my claim with the lender directly, through the Financial Ombudsman Service or any public compensation scheme, including any industry wide redress scheme. Whilst we will always strive to get you the maximum amount of compensation possible, there is no guarantee that we will recover any more than you may achieve if you pursued the claim on your own.
I consent to a soft credit search through Valid8, who will obtain an Electronic Credit Report from Equifax and pass on all information collected about me to Benson Goldstein.
I agree to Valid8 IP’s privacy policy.. I understand that a soft footprint will be retained on my credit file which will not affect my credit score.

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Base64 Signature

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Your Details

Your Address

The final bit