Pensions Ombudsman - Publications


11 Belgrave Road London SW1V 1RB Telephone: 020 7834 9144 Fax: 020 7821 0065 enquiries@pensions-ombudsman.org.uk

This form can be completed whilst online if required. Alternatively you can fill it in offline and then go online to submit the form. As some of the fields may be time consuming to type in, answers could be prepared previously offline in a word processor package and then copied into the relevant fields in the form before submitting the form.

Please ensure that you have all supporting documents you want to submit held in electronic format and that they are of one of the allowed file types (doc, rtf, xls, pdf, txt, gif, jpg / jpeg and zip). You are allowed to attach a maximum of three files with any form. Each file must be less than 500k or the form will not pass them.

Note: Fields marked with * are compulsory.

Complaint Form sub-sections:

Personal details
Details of parties
What have the parties done wrong
Previous referrals
Representation

Section 1 - Personal Details

Title:

*Initial:

*Surname:

*Address line 1:

*Address line 2:

Address line 3:

Address line 4:

Address line 5:

*Post code:

Telephone (optional):

Date of Birth:

Day:

Month:

Year:

Email (optional):

Section 2 - Details of parties

Scheme name:

My complaint (and / or dispute) is with (please complete as appropriate):

Employer/s

*Employer/s name:
*Address line 1:
*Address line 2:
Address line 3:
Address line 4:
Address line 5:
*Post code:
Telephone (optional):
Email (optional):

Trustees

*Trustees name:
*Address line 1:
*Address line 2:
Address line 3:
Address line 4:
Address line 5:
*Post code:
Telephone (optional):
Email (optional):

Manager/s

*Manager/s name:
*Address line 1:
*Address line 2:
Address line 3:
Address line 4:
Address line 5:
*Post code:
Telephone (optional):
Email (optional):

Administrator/s

*Administrator/s name:
*Address line 1:
*Address line 2:
Address line 3:
Address line 4:
Address line 5:
*Post code:
Telephone (optional):
Email (optional):

Section 3 - What have the parties done wrong

Complaint

My complaint is (please enclose copies of all relevant correspondence if not held by the Pensions Advisory Service):

The date I became aware of this was:

Day:

Month:

Year:

Relevant Correspondence

Please include any relevant correspondence that is available in electronic format. Copies of this form and any files received will be sent for comment to the respondents.

Available file formats:
Files must be of the following formats (All other file formats will be discarded):

Document formats

MS Word (DOC)
Plain text (TXT)
Rich Text Format (RTF)
Portable Document Format (PDF)
MS Excel (XLS)

Graphic formats

Graphics Interchange Format (GIF)
Joint Photographics Expert Group (JPG or JPEG)

In addition compressed files in ZIP format are accepted. This format is preferable when sending large documents.

File 1:

File 2:

File 3:

Additional files can be sent by attaching them to an email to the Pensions Ombudsman

Details

Please detail the injustice you have suffered (please refer to page 5 of the booklet):
Injustice details

Putting it right

To put the matter right I would like:
Rectifying details

Section 4 - Previous Referrals

Details

Has your complaint been referred to the Pensions Advisory Service?	Yes No

Are we allowed to request your papers from them?	Yes No

What is your Pensions Advisory Service reference number?

Have any of the following been involved in this complaint:
The Courts or any Tribunal?	Yes No

If so, please give details (including reference numbers):
Courts / Tribunal details

Please note that we can request information during the course of our investigation and any papers received may be copied to all parties.

Representation

Is someone representing you?

Yes No

If yes, who?