CLIENT COMPLAINTS REGISTRATION FORM
1. PERSONAL DETAILS:First Name: Last
Name: Residential
Address: Post Code/
Zip Code: City/Town:
State/Province:
Country:
Home Phone:
Mobile Phone:
E-mail:Account

number:Equity before:
after:

EquityClaimedMagnitude of damage:Your Account Service Manager:
Company’s organizational unit/department involved:

2. BRIEF SUMMARY OF YOUR COMPLAINT:
Please describe the product of service you are complaining about (Description, Evidence and suggested way to be solved);(If the below space is not convenient or sufficient for your explanation, please use a separate sheet and attach it to thisform).

Please enclose/attach any other relevant documentation (including any correspondence exchanged with the Company)that may help us handle your complaint.

Signature
Name & Surname
Date

FOR INTERNAL USE ONLY
Complaint received by: …………………………………………................................................................………………………………………………………… ………………..
Date of reception: …………………….................................................................……………………………………………………………………………………………………….
Reference number: …………….................................................................………………………………………………………………………………………………… …………..
Service/department to which the complaint refers: …...........................................................................................................................................
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Details of the employee responsible for the service/s rendered to the client: …...................................................................................................
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Organizational unit/department where the relevant employee, which is responsible for the service/s rendered to the client,belongs:...............….......................................................................................................................................................................................

Initial response to client:

Yes

Check BoxNo

Check Box

Date: ………….............................................................

Initial Action Taken: ………………………………..............................................................……………………………………………………………………………………………..

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Informed Client of Initial Action Taken: Yes

Check BoxNo

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Date: ……........................…………………………

Check BoxNo
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Date:
Further Action Taken:
Yes……................................................................................…
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File handed on to Compliance Officer: Yes
Settlement of Complaint:

Yes

Check Box

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NoNo

Check Box

Check Box

Date: …………...........................…………………
Date: ……………..........................................………………

Summary of how the complaint was settled:………………………...............................……………………………………………………………………………………………..
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Signature of responsible Officer:
Date: …………………..........................................................................…………