Customer Complaints Form

Customer Complaint Form

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Your Details

Title *— Select —MrMrsMissDr

First Name *

Last Name *

Phone Number *

Email *

Address *

Branch *— Select —Accra(Head Office)AdentaEast LegonTemaKoforiduaKumasi AdumKumasi BantamaSunyaniTakoradiTarkwaCape CoastTamale

Policy Type *— Select —MotorFireGeneral AccidentBondTravelClaimsOnlineOther Concerns

Relations Officer *

Date Complaint Occurred *

Your Complaint

Subject *

Let us know your concern *

Supporting Documents (optional)

Supporting File 1

Supporting File 2

Supporting File 3

What is 8 + 7? *

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