Consumer Complaint Registration Form


 

Complainant Section (please complete in full)

Person Dealing with Complaint (Complainant):

Tel No:

Fax No:

Person to be Contacted, if different from above:

Tel No:

Fax No:

Consumer Address:

Service Description:

Contract Ref (if applicable):

Date Problem Encountered:

Description of Complaint:

Remedy Requested:

*YES *NO *Delete where applicable

Enclosure(s):

List Documents attached

Signed:

Dated: