Policyholder Complaint Form

POLICYHOLDER COMPLAINT FORM

If you have a complaint about insurance at Lloyd’s, the Managing Agent Services department may be able to help you to resolve it.

For full details, please see our web page. You can contact us for help or advice on 0207 327 5693 or e-mail [email protected]

It would help us to deal with your complaint if you complete as much of this form as possible. If you do not know something, or it does not apply to you or your complaint, just leave it blank or write ‘N/A’ or ‘not applicable’ in the relevant section.

Please complete in block capitals

ABOUT YOU Policyholder details details of any representative acting for you (A representative can be a professional adviser or just a friend or family member) Mr/Mrs/Ms ………………………………………….. First Name ...... ….. . . . Name ...... … ………………...... Surname ...... ……... Address...... ………………...... Address ...... …………..……...... ………………… ...... Postcode ...... …………………. . . . Postcode ...... Your Ref...... …………………... . . Contact Telephone No...... ………. . Contact Telephone No. …………………. Email ...... ……...... Email ...... …………………… If your complaint concerns your business Name of Company or Business ...... ……………………. … (If you are a business)

Group Annual Turnover € ...... (An approximation would help if you do not know)

(We are generally only able to handle complaints brought by consumers and small businesses, A business is small for this purpose if it has a group annual turnover of less than €2m and fewer than ten employees. We may require supporting evidence, e.g. excerpt from company accounts).

ABOUT YOUR Insurance POLICY

Who did you buy the insurance from? Type of insurance (i.e. Name of Broker or Agent) (e.g. Motor/Household etc) Name ...... …………………...... Address ...... ……… When did this insurance policy start?

...... / /

………………………………………………………………. If known supply the Lloyd’s syndicate which provides the insurance? Telephone No...... Broker ref...... ………………...... Please state the Policy or Certificate number ......

It would help if you could attach a copy of the policy certificate or schedule and any other relevant documents you may have.

About your complaint Lloyd’s is authorised under the Financial Services and Market Acts 2000 Who is your complaint against? ...... ……………………………. (i.e. Name of firm)

Does your complaint relate to a claim? YES*/NO (circle as appropriate)

*If YES, when did the claim occur? / /

Please give the claim number ......

If your complaint concerns motor insurance, please give the vehicle registration number of the vehicle concerned ......

The fos Have you contacted the Financial Ombudsman Service (FOS) about your complaint?

YES* /NO circle as appropriate *If YES, please give their reference......

FOS will consider your complaint only once you have tried to resolve it with us, so please take up your concerns with us first and we will do what we can to help. Please give a brief summary of your complaint (Using a separate sheet if you need more space).

______

Please also attach copies of any correspondence you have received relating to your complaint

WHAT SOLUTION TO THIS COMPLAINT DO YOU THINK WE SHOULD REACH?

______

Lloyd’s is authorised under the Financial Services and Market Acts 2000 Data Protection

I would like Market Services to consider my complaint.

• I acknowledge that Market Services holds my personal data, including personal data ("Personal Data"), which I have provided. • I consent to Market Services processing my Personal Data for the purposes of considering my complaint. • I consent to my Personal Data being disclosed by Market Services to third parties for the purposes of considering my complaint.

...... Policyholder Signature Date: / /

...... Date: / / Representative Signature (if applicable)*

What to Do next?

Please return your completed form, together with any attachments to the address below.

Managing Agent Services Market Services Telephone: (020) 7327 5693 Lloyd’s Fax: (020) 7327 5225 Fidentia House, Email: [email protected] Walter Burke Way, Chatham Maritime Website: www.lloyds.com Kent ME4 4RN

We will contact you within 2 working days to confirm receipt and explain how we will handle your complaint.

Lloyd’s is authorised under the Financial Services and Market Acts 2000