Complaint Form

Please complete all the required fields marked with an asterisk (*).

1. PERSONAL PARTICULARS OF COMPLAINER

Full Name(*)
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Address(*)
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Number(*)
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Town/Village(*)
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Postal Code(*)
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Telephone(*)
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Mobile phone
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Fax
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Email(*)
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Do you have a Policy with us?(*)
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Policy Number(*)
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Do you submit a complaint on behalf of another Policy holder?(*)
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Policy Number(*)
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Preferred way of communication during investigation:(*)
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2. DETAILS OF COMPLAINT

Type of Complaint(*)
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Please Specify(*)
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Does your complaint relate to a particular employee?(*)
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State the full name of the employee(*)
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Does your complaint relate to a particular department of the Company?(*)
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State the name of the department:(*)
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3. BRIEF DESCRIPTION OF THE COMPLAINT

 To enable us to provide the best service to you, we advise you to give specific dates and time, names and details relating to the case. If there are any documents relating to your case, please attach them to this form. It would be useful if you let us know what you would wish the company to do, so that you will be satisfied with the arrangement.

(*)
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Attach document
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Security(*)
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