Complainant's Details

Surname

First Names

Postal Address

Contact Details

Cell No

Home No

Work No

Fax No

e-mail

Preferred method of Communication

Transaction Details

Representative's Name

Branch

Product Name

Reference

Date of Transaction / Incident

Summary of Complaint

Please attach all supporting documentation relevant to the complaint

COMPLAINT REGISTER AND PROGRESS REPORT

Company Name

Date Received

Complaint Handler

Complaint No

Company Representative

Designation

NAME OF CLIENT

Client Address

Client Contact Details

Cell

Home

Work

e-mail

Fax

COMPLAINT DETAIL

Complaint received by

Describe Other

Date Received

Date of Initial Response

Client Expectation

SUPPLY CHAIN

Are there any other parties in the supply chain involved?

Any evidence of 3rd party responsibility?

Has contact been made with the 31st party/ies?

Date Contacted

Confirmed in writing with supporting documents

Initial Response

Supply Chain Contact Details

Company Name

Contact Person

Tel No

Fax No

Cell No

e-mail

Website

Type

Describe Other

SLA/Vendor Contract

Client Response

Date

Reason for Rejection

Ombud Referral

Date

Outcome from Ombud

Final Result

Date

Date Finalised

Signed off by

TIME LINE IN RESPECT OF COMPLAINT HANDLING

CLIENT NAME

COMPLAINT NO

Date & Time

Contacted

Contact No

Comments

Date & Time

Contacted

Contact No

Comments

Date & Time

Contacted

Contact No

Comments