The information given to us in this questionnaire will enable us to accurately assess your claim.
Name
*
Mr
Mrs
Miss
Ms
Dr
Email
*
Brief description of Data Breach
Date of the incident
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Day
/
Month
Year
Date
What date did you discover the data breach
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Day
/
Month
Year
Date
Data Breach Company details
Have you reported the breach to either the Company, the ICO or the Police?
Company
ICO
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Other
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Nationality
Are you currently a UK resident?
Yes
No
Please give any further details about the data breach
Your information will be reviewed by a Solicitor and in some cases an expert Barrister - By submitting your details you are agreeing to this.
Do you have a company account number or reference
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Phone Number
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Date of Birth
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Year
Date
Are you happy for us to contact you regarding this?
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How did you find KP Law?
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