claim.morsesclub.com
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18.173.233.67
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URL:
https://claim.morsesclub.com/
Submission: On December 19 via automatic, source certstream-suspicious — Scanned from DE
Submission: On December 19 via automatic, source certstream-suspicious — Scanned from DE
Form analysis 1 forms found in the DOM
<form id="myForm">
<p> 1. Did you submit a claim in the Morses Club Scheme? </p>
<div class="radio-group">
<input type="radio" id="morses-scheme-yes" name="morses-scheme" value="yes">
<label for="morses-scheme-yes">Yes - You do not need to submit a Customer Claim Form as we already have details of your claim</label>
</div>
<div class="radio-group"> <input type="radio" id="morses-scheme-no" name="morses-scheme" value="no"> <label for="morses-scheme-no">No - please click continue</label>
</div>
<br>
<div class="form-field">
<label for="customerId">2. Your 8 digit Customer ID (starts with 0,1,8 or 9)</label>
<input type="text" id="customerId" name="customerId" maxlength="8" required="">
</div>
<div class="form-field">
<label for="msrnNumber">2. Your 12 digit MSRN number (optional)</label>
<input type="text" id="msrnNumber" name="msrnNumber" maxlength="12">
</div>
<div class="form-field">
<label for="firstname">3. Your first name:</label>
<input type="text" id="firstname" name="firstname" required="">
</div>
<div class="form-field">
<label for="lastname">4. Your surname:</label>
<input type="text" id="lastname" name="lastname" required="">
</div>
<div class="form-field">
<label for="address">5. Your full address:</label>
<input type="text" id="address" name="address" required="">
</div>
<div class="form-field">
<label for="dob">6. Your date of birth</label>
<input type="text" id="dob" name="dob" placeholder="mm/dd/yyyy" required="">
</div>
<div class="form-field">
<label for="phoneNumber">7. Your phone number:</label>
<input type="text" id="phoneNumber" name="phoneNumber" required="">
</div>
<div class="form-field">
<label for="email">8. Your email address:</label>
<input type="email" id="email" name="email" required="">
</div>
<h2>Section A - CLAIM FORM AND CUSTOMER / REPRESENTATIVE DETAILS</h2>
<h3>Part 2</h3>
<p> The information in Part 2 below is optional and only needs to be completed if you are a representative for a Customer </p>
<p> Complete this Part 2 if you are a Representative </p>
<p> 9. Are you a representative? </p>
<div class="radio-group">
<input type="radio" id="representative-yes" name="representative" value="yes">
<label for="representative-yes">Yes</label>
</div>
<div class="radio-group">
<input type="radio" id="representative-no" name="representative" value="no">
<label for="representative-no">No</label>
</div>
<div id="representative-section" style="display:none;">
<div class="form-field">
<label for="rep-full-name">9a. Representatives full name:</label>
<input type="text" id="rep-full-name" name="rep-full-name">
</div>
<div class="form-field">
<label for="rep-full-address">9b. Representatives full address:</label>
<input type="text" id="rep-full-address" name="rep-full-address">
</div>
<div class="form-field">
<label for="rep-phone-number">9c. Representatives phone number:</label>
<input type="text" id="rep-phone-number" name="rep-phone-number">
</div>
<div class="form-field">
<label for="rep-email">9d. Representatives email address:</label>
<input type="email" id="rep-email" name="rep-email">
</div>
</div>
<h2>SECTION B - CLAIM DETAILS</h2>
<h3>THE SECTION BELOW IS OPTIONAL. HOWEVER, PLEASE COMPLETE IT AND PROVIDE INFORMATION IF IT IS RELEVANT TO YOU</h3>
<p>Other information if relevant</p>
<p> We may take into account if you may not have been able to understand whether you could afford the loan if you suffered from certain medical conditions (such as Alzheimer's, Dementia or a brain injury) or a mental health condition. </p>
<p> We will also take into consideration any other factors that may have been relevant at the time you took out the loan that you would like to submit in support of your claim (for example, evidence of a vulnerability or any relevant circumstances
or interactions that you had with Morses Club at the time). </p>
<p> IMPORTANT NOTE: We may ask you to provide further information to support your claim. </p>
<p> 10. Do you believe you have additional information to support your claim? Please select yes or no </p>
<div class="radio-group">
<input type="radio" id="additional-info-yes" name="additional-info" value="yes">
<label for="additional-info-yes">Yes</label>
</div>
<div class="radio-group">
<input type="radio" id="additional-info-no" name="additional-info" value="no">
<label for="additional-info-no">No</label>
</div>
<div id="medical-conditions" style="display:none;">
<div class="form-field">
<label for="medical-condition">10a. Please state the nature of the medical or mental health condition:</label>
<textarea id="medical-condition" name="medical-condition" rows="4" style="width: 100%;"></textarea>
</div>
<div class="form-field">
<label for="medical-condition-when">10b. Please state when you had this medical or mental health condition (year when the condition started and if applicable the year the condition ended):</label>
<textarea id="medical-condition-when" name="medical-condition-when" rows="4" style="width: 100%;"></textarea>
</div>
</div>
<button type="submit" class="submit-button" style="width: 100%; background-image: linear-gradient(to top, #0071BB, #0090ee)">Submit</button>
</form>Text Content
(IN ADMINISTRATION) * You can use this Claim Form to submit a claim to Morses Club Limited * Should you have submitted a claim in the Morses Club Scheme, you do not need to submit a further Claim Form To make a claim complete both Sections A and B 1. Did you submit a claim in the Morses Club Scheme? Yes - You do not need to submit a Customer Claim Form as we already have details of your claim No - please click continue 2. Your 8 digit Customer ID (starts with 0,1,8 or 9) 2. Your 12 digit MSRN number (optional) 3. Your first name: 4. Your surname: 5. Your full address: 6. Your date of birth 7. Your phone number: 8. Your email address: SECTION A - CLAIM FORM AND CUSTOMER / REPRESENTATIVE DETAILS PART 2 The information in Part 2 below is optional and only needs to be completed if you are a representative for a Customer Complete this Part 2 if you are a Representative 9. Are you a representative? Yes No 9a. Representatives full name: 9b. Representatives full address: 9c. Representatives phone number: 9d. Representatives email address: SECTION B - CLAIM DETAILS THE SECTION BELOW IS OPTIONAL. HOWEVER, PLEASE COMPLETE IT AND PROVIDE INFORMATION IF IT IS RELEVANT TO YOU Other information if relevant We may take into account if you may not have been able to understand whether you could afford the loan if you suffered from certain medical conditions (such as Alzheimer's, Dementia or a brain injury) or a mental health condition. We will also take into consideration any other factors that may have been relevant at the time you took out the loan that you would like to submit in support of your claim (for example, evidence of a vulnerability or any relevant circumstances or interactions that you had with Morses Club at the time). IMPORTANT NOTE: We may ask you to provide further information to support your claim. 10. Do you believe you have additional information to support your claim? Please select yes or no Yes No 10a. Please state the nature of the medical or mental health condition: 10b. Please state when you had this medical or mental health condition (year when the condition started and if applicable the year the condition ended): Submit