GAP Insurance Form

1
Your Information
2
Check Your Eligibility
3
Declaration and
Consent
4
Review and Sign
5
Agreement Information
6
Questionnaire Form
7
Questionnaire Form
First Name *
Last Name *
Email *
Phone *
Street Address
City
State/Region/Province
Country

GAP Insurance Form

1
Your Information
2
Check Your Eligibility
3
Declaration and
Consent
4
Review and Sign
5
Agreement Information
6
Questionnaire Form
7
Questionnaire Form
Did you purchase GAP insurance when you bought or financed your vehicle? *
Do you remember how the GAP insurance was sold — for example, was it added by the dealership or finance company at the same time as your vehicle purchase? *
Were you clearly told that GAP insurance was optional and that you could buy it elsewhere, possibly at a lower cost? *

GAP Insurance Form

1
Your Information
2
Check Your Eligibility
3
Declaration &
Consent
4
Review and Sign
5
Agreement Information
6
Questionnaire Form
7
Questionnaire Form
Additional Information

Please provide any other information you feel is relevant to your purchase or experience of GAP insurance.

GAP Insurance Form

1
Your Information
2
Check Eligibility
3
Declaration &
Consent
4
Review & Sign
5
Agreement Information
6
Questionnaire Form
7
Questionnaire Form
Signature
Our Agreement With You (PLEASE SCROLL AND READ THE COMPLETE DOCUMENT TO ACKNOWLEDGE)
I acknowledge and agree that by electronically signing this document, I accept and consent to be bound by the terms and conditions of the Retainer Agreement set out above. I further acknowledge and consent that my electronic signature, together with the information I have supplied in this application, will be used to generate a completed Retainer Pack in my name, and that an executed copy of the Retainer Pack will be delivered to me at the email address I have provided. I also confirm that I have carefully read and fully understood the terms and conditions set out in the Retainer Agreement.

Form Summary

Your Information
Name *
Email *
Phone *
Address
Check Your Eligibility
Do you remember how the GAP insurance was sold — for example, was it added by the dealership or finance company at the same time as your vehicle purchase? *
How was GAP insurance sold? *
Were you clearly told that GAP insurance was optional and that you could buy it elsewhere, possibly at a lower cost? *
Declaration and Consent
Type here...
I confirm the information I’ve provided is true and accurate to the best of my knowledge. *
I consent to my data being used to review the sale of my GAP insurance and, where appropriate, to assist with raising a formal complaint or claim. *
Review and Sign
Signature
I acknowledge and agree that *

GAP Insurance Form

1
Your Information
2
Check Your Eligibility
3
Declaration & Consent
4
Review and Sign
5
Agreement Information
6
Questionnaire Form
7
Questionnaire Form

GAP Insurance Form

1
Your Information
2
Check Your Eligibility
3
Declaration & Consent
4
Review and Sign
5
Agreement Information
6
Questionnaire Form
7
Questionnaire Form
1. GAP Insurer Name *
2. Do you have a copy of your policy document? *
Do you recall being given the full policy documents and a clear explanation of how any claim would be calculated before you agreed to the policy?
3. Approximate Cost *
4. Did the product seller wait at least two clear days after the sale of the car before selling the GAP insurance? (post 2015 only) *
5. Where did you buy the GAP insurance? *
Do you know whether the GAP policy term matched the length of your finance agreement or how long you expected to keep the vehicle?
Did you pay a large deposit (over 30%), leaving only a small finance balance?
Was the vehicle purchased outright with cash (no finance)?
Did the dealer or manufacturer already include “return-to-invoice” or a similar protection in the package?
Was the GAP premium added to your finance agreement so that you paid interest on it?
Was the vehicle used mainly for business or commercial purposes?
At the time you bought this policy, did you already have another GAP or shortfall policy in place?
6. Did the salesperson explain what GAP insurance covers and how it works? *
Did anyone assess your needs or financial situation before selling you GAP insurance?
Were all key details clearly explained before you agreed to the policy — including cost, optional nature, ability to buy elsewhere, and major exclusions?
Were you told about important exclusions (e.g. mileage or age limits, usage restrictions, theft-only cover)?
Were you informed of your right to cancel the policy and how to do so?
Did the salesperson describe the GAP policy in a way that made it seem more necessary or more valuable than it really was?
7. Were you told that GAP insurance was optional and not required? *
8. Were you told you could buy GAP insurance elsewhere, possibly at a lower cost? *
9. Did you feel pressured or rushed into taking the policy at the time of sale? *
Looking back now, do you feel the GAP insurance was unnecessary or not suited to your circumstances?
Did any personal circumstances (health, bereavement, stress, language, age, or financial difficulty) make it harder for you to assess the policy at the time?
Did you have limited understanding of financial products or need extra support?
Yes No Not Sure
Did you experience language or communication barriers during the sale?
Yes No
Were you aged 65 or over and relying heavily on the salesperson’s advice?
Yes No Prefer not to say
Did a physical or mental health condition affect your ability to understand the policy?
Yes No Prefer not to say
Were you experiencing bereavement, stress, or emotional distress during sale/claim?
Yes No Prefer not to say
Were you in financial difficulty or heavily reliant on credit at the time of the vehicle purchase?
Yes No Prefer not to say
Did you believe the GAP policy was mandatory under your finance agreement?
Yes No Not Sure
10. Were you told that your car insurer might already cover the first 12 months on a new vehicle (“new for old” cover)? *
Did your motor insurer’s “new for old” cover overlap with the GAP policy period?

GAP Insurance Form

1
Your Information
2
Check Your Eligibility
3
Declaration & Consent
4
Review and Sign
5
Agreement Information
6
Questionnaire Form
7
Questionnaire Form
11. Were you told that the dealership/broker or finance company would receive a commission or payment for selling the GAP insurance? *
Were you given details or a calculation of the commission amount?
12. If you had known a commission was being paid, do you think it might have affected your decision to buy the policy? *
13. Did you feel the salesperson was more focused on selling the insurance than explaining whether it was right for you? *
14. Have you ever made a claim on your GAP policy? *
Did you experience long delays in your claim being processed or paid, even after you had provided all requested documents?
Were you kept clearly and regularly informed about the progress of your claim?
Was the claim paid in full?
Please explain what happened:
Did the insurer clearly explain any deductions or reductions from the claim amount?