Online Complaint Submission

1. YOUR INFORMATION

2. WHO IS YOUR COMPLAINT AGAINST?

Title

Name/Firm *

Name:

Firm Address *

Address

Firm Phone *

Age

Firm Email *

Phone

Firm website *

Email

Person you dealt with *

Occupation

When did transaction take place *

Date

Time

Nationality *

Date *

Date

Time

3. INFORMATION ABOUT THE TRANSACTION

Date of transaction or event *

Date

Time

Did you sign a contract? if yes attach a copy or receipt *

Yes
No

Contract/Receipt

Click or drag a file to this area to upload.

Name of product or service *

Amount Paid *

4. RESOLUTION SOUGHT

What would you consider a satisfactory resolution to this matter? *

Refund
Product Delivery/Exchange
Service Performed
Other

If other, please give details below: *

If you are seeking a refund, please state amount in Kwacha *

I am not seeking a resolution to this matter but I am filing a complaint for reporting purposes *

Yes
No

4. ACTION YOU HAVE TAKEN

Have you complained to the business or organisation? If yes attach a copy of the complait. *

Yes
No

Attach copy of compalint

Click or drag a file to this area to upload.

How did you lodge the complaint? *

Through Email
By Telephone
In Person

Date of Complaint *

Date

Time

Person Contacted *

Action taken/ response: *

Have you complained to another agency? *

Yes
No

If Yes, which agency

and when

Date

Time

What Action was taken

Have you contacted a private lawyer *

Yes
No

Have you started a court action *

Yes
No

If yes, attach court document

Click or drag a file to this area to upload.

1. YOUR INFORMATION

2. WHO IS YOUR COMPLAINT AGAINST?

3. INFORMATION ABOUT THE TRANSACTION

4. RESOLUTION SOUGHT

4. ACTION YOU HAVE TAKEN

6. DESCRIBE YOUR COMPLAINT IN DETAIL.

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