Application Form

POSTRS Enquiry Number:
(if applicable)

Applicant contact details

Title: *
Forename: *		Please put your full name and not just your initials
Surname: *
Organisation: (if applicable)
Daytime Phone Number: *		Numbers only please
Fax Number:
Email: *
Address: *




Postcode: *
How did you hear about us? *

If you have a representative acting for you, please give their details below. ALL correspondence will be sent to this person at this address.

Details of the claim

Complaint about: *
Dispute Type: *
Date you first complained: *
If the company gave you a reference number, enter it here:
If the company gave you a deadlock number, enter it here:

What you want the company to do

If you want to claim compensation, fill in the next section.

Direct loss as a result of you using the relevant product or service
Give you money to compensate for your loss:

How much? *
* The amount you claim here cannot be more than the maximum level of compensation set out in the terms and conditions of the mail product you used. You must put an amount in this box if you want the adjudicator to tell the company to give you money for this reason, and you must provide evidence to justify the amount you are claiming. You cannot change the amount later. If the adjudicator decides in your favour, they could award any amount of money up to this figure.

Problems in the way the company handled your complaint.

Give you money to compensate for any stress, anxiety or inconvenience caused by the company failing to keep to its own procedure for handling complaints

How much? *
* The amount you claim here cannot be more than £50. You need to put an amount in this box if you want the adjudicator to tell the company to give you money for this reason. You must also provide evidence to justify the amount you are claiming, and to show that the company has not kept to its own procedure for handling complaints. You cannot change the amount later.

Dispute Details *

Please Provide a summary of your complaint:

The summary should include all relevant facts and issues needed to help the adjudicator to understand your claim, you have a max of 750 words.

I understand and accept all of the conditions in the Information for customers guide.
I have read and understood the POSTRS rules.

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