To receive our no obligation claim pack, complete the form below and click 'Finish' at the bottom of the page. You can submit a claim directly to the lender yourself for no charge. You can also approach the Financial Ombudsman Service and Financial Services Compensation Scheme for free to review your case, providing you satisfy their requirements.

Name*:	Mr. Mrs. Miss Ms. Dr. Prof. Rev. Other Mr/Mrs Mr. & Ms. Messrs Mrs and Ms Mrs and Mrs	Your title, first name and surname
2nd Account Name:		2nd firstname/lastname (joint accounts)
Address*:		Your house/flat name/number and street
Address (cont):		The remainder of your address
County:		The county you live in
Postcode*:		Your postcode
Date of Birth:		Your date of birth (dd/mm/yyyy)
2nd Date of Birth:		Joint accounts only (dd/mm/yyyy)
Home/Mobile Phone 1*:		Your mobile or home number
Home/Mobile Phone 2:		Home/mobile/work tel. number
Source ID:		Leave blank if you do not have one
Email:		Your email address
I have read and understand the notes below.

Details marked with a * must be completed.  For assistance, E-mail: support@bank-smart.co.uk

NOTE: Full terms and conditions will be provided with your no obligation claim pack, please make sure you read and understand them fully before signing and returning to us. Simply complete the form above and click Finish. You are under no obligation to use Bank-Smart until you sign the contract and return it to us by post which will be sent to you within 3 working days.