1. Your Details

First name: Surname: Date of birth: Address line 1: Address line 2: Address line 3: (Optional) Contact number: Are you a PTSB customer?

2. Your complaint

Is your complaint in relation to a product or a service? Please describe the experience that has not met your expectations: 0/1000 characters What would resolve this for you? 0/1000 characters Have you raised this with us previously?

3. Special Category: Personal Data

If, as part of your complaint, you have volunteered information which is considered special categories of personal data (i.e. data revealing racial or ethnic origin, political opinions, religious or philosophical beliefs, trade union membership, genetic or biometric data, or data concerning health, sex life or sexual orientation) and/or information relating to criminal convictions/offences, we will need your explicit consent before we can process such data (e.g. to consider this information when assessing your complaint). If you consent to us processing this data in relation to your complaint, please tick.

4. Security Check

Please ensure you are using a secure network/device to protect against your data being cached.