National Consumer Commission

Form· Complaint - section 71(1)

Full names of complainant

ID/Registration number of complainant

Postal Address

Physical Address

Cell phone number

Landline number

Fax number

E-mail address

When is the best time to contact you, should this be necessary?

Has the complainant previously filed a complaint with the NCC?

If so, please provide the reference number

Nature of complaint

Provision of Consumer Protection Act or regulations promulgated under it or Code contravened (if known)

Name of company or person against whom complaint is made

Address of company or person against whom complaint is made

Short description of complaint

Details of steps taken to resolve the complaint

List of documents relevant to complaint attached to this form

What outcome do you propose for this complaint?

Date

Place

Signature

Office use only

Reference number