*Please complete this electronic questionnaire with details of your personal experience as a result of the TalkTalk data breach. We will use this information to assess and build your case and it is important that you provide us with as much information as possible to enable us to really understand what has happened in your individual case. We anticipate that the questionnaire will take 20 – 30 minutes to complete (the time it will take is related to the amount of information/ documentation you can provide). It is important to note that once you start the electronic questionnaire you will need to complete the entire questionnaire in a single session (as the information you have provided will be forgotten and you would need to restart the questionnaire afresh). Once you have submitted your information at the end of the questionnaire the data will be captured and saved to the required fields within your matter; which is why we are asking you to complete some data that we already hold e.g. name, dob, address.
(Please note * denotes a mandatory field that must be completed to progress through the questionnaire)
If you have any problems completing this electronic questionnaire please do not hesitate to contact us: by calling our dedicated TalkTalk data breach helpline on: 020 3780 0454 or by email on: email@example.com
If you would prefer to complete a paper copy of this questionnaire please let us know and we will send this to you through the post.
Alternatively, if you would prefer to be taken through the questionnaire, by telephone, a member of our legal team can contact you for this purpose.
Again, please just let us know your preferred method for completing the questionnaire using the contact information detailed above.
(Give an approximate date if exact date not known)
(For example:(i) internet/ broadband services; (ii) TV services; (iii) Land line telephone services (iv) TalkTalk mobile)
(If you have been notified on more than one occasion please state on how many occasions)
(If you have been contacted on more than one occasion please state each date you were contacted on. Please provide approximate date(s) if you cannot recall the exact date(s))
(If so, please send that documentation to us when completing the questionnaire by using the Sharefile system – following the details provided in our cover email - or by post)