1. Client Identification
Full name
Email address
Secure
Telephone number
Secure
Postcode
Postal address
Secure
2. Vehicle Details
Vehicle registration number
Vehicle make & model
Select Manufacturer
Volkswagen
Audi
SEAT
Škoda
Porsche
Mercedes-Benz
BMW
MINI
Vauxhall
Opel
Peugeot
Citroën
DS Automobiles
Fiat
Jeep
Alfa Romeo
Renault
Nissan
Dacia
Ford
Jaguar
Land Rover
Volvo
Toyota
Lexus
Hyundai
Kia
Mazda
Honda
Mitsubishi
Suzuki
Year of manufacture
Fuel type
Select
Diesel
3. Purchase Information
Purchased from
Select
Motor dealer
Manufacturer
Private sale
Other
Purchase date
4. Emissions & Disclosure
Was the vehicle advertised or described as Euro 5 / Euro 6 compliant?
Yes
No
Don’t know
Were you told the vehicle met emissions standards in real-world driving?
Yes
No
Don’t know
5. Knowledge & Reliance
If you had known the true emissions position, would you have acted differently?
Yes
No
6. Impact & Loss
Paid more than the vehicle was worth?
Yes
No
Reduced resale value?
Yes
No
ULEZ / Clean Air Zone charges?
Yes
No
Other financial impact?
Yes
No
Please describe the other financial impact
7. Remedy Requested
What outcome are you seeking?
Compensation
Price reduction
Alternative resolution
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