Protective Registration

CIFAS Protective Registration Service In order for CIFAS to offer you an optimum service, please complete this form in as much detail as possible. (Fields marked with * are mandatory – this information must be supplied)

Mr/Miss/Mrs*

First Name(s)*

Surname*

Date of birth*

Main registrant: Any other members of household over the age of 16:

Current Address*

Postcode* At address since (Month/Year)* Home tel. no. Previous address(es)* complete only if less than 5 years at current address (use additional sheets if necessary):

Postcode Period at address (approx.)

Postcode Period at address (approx.)

From: To:

From: To:

If you are employed or self-employed please complete the following section. Please tick all relevant boxes:

Employed

Self-employed

Full time

Part time

Other

Job title Name & Address of employer Time with employer Work contact tel. no.

You may add an additional security feature in the form of a password – for example a pet’s name or memorable date – which may then be requested by lenders if they receive an application from your address. If you wish, please provide details below (max 8 characters) along with a question/statement to remind you of your password. Password

Reminder

Why do you require Protective Registration? Has the incident been reported to Police? Police Force

Yes/No Incident / Crime Reference No.

How did you find out about Protective Registration? (Please tick) Police

Equifax

CIFAS website

CAB

Other

Protective Registration is subject to an administration charge of £11.75 (incl. VAT). Payment details must be provided before Protective Registration can be taken out. Please indicate payment method: Cheque/P.O. Switch/Delta/VISA/MasterCard

Please make payable to ‘CIFAS’ & enclose with this form to address below Name of account holder Expiry Date Card No. Issue No. (Switch only)

NOTIFICATION CLAUSE I hereby request Protective Registration under the CIFAS – The UK’s Fraud Prevention Service’s scheme, and declare that the information supplied in this application is true and correct. I agree to the information being made available to the members of CIFAS and to fraud prevention agencies participating in CIFAS. They may use and search these records to: • Help make decisions about credit and credit-related services for me and members of my household • Help make decisions on motor, household, credit, life and other insurance proposals and insurance claims, for me and for members of my household • Trace debtors, recover debt, prevent fraud, and to manage my accounts or insurance policies • Check my identity to prevent money laundering, unless I furnish them with other satisfactory proof of identity. I am aware that CIFAS and the fraud prevention agencies will also use the records for statistical analysis about fraud. I note my right, on payment of a fee, to receive a copy of the information you hold about me if I apply to you in writing. I understand that Protective Registration will remain on the CIFAS database for minimum of twelve (12) months. I understand that Protective Registration is a benefit to me, CIFAS and its Members. I accept that CIFAS and its Members will make all reasonable efforts to protect me from fraud. I understand that Protective Registration may result in a slight delay to any applications I or other members of my household make whilst checks are carried out. By signing this document you signify that you have read, understood and agree to the Notification Clause above.

Signed*

Date*

Email address Please return completed form to:

CIFAS, PO Box 1141, Bradford BD1 5UR