COMPLAINANT'S DETAILS

Full Name *

Address

Residential *

Postal

Contact Details

Telephone *

Mobile

Other (e.g., next of kin, relative, etc.)

Other Contacts

Email

Fax

Occupation

Age
Under 18 18-25 26-35 36-45 46-55 56+

Place complaint lodged
SuvaLautokaLabasa

RESPONDENT'S DETAILS

Full Name

Address

Residential

Postal

Contact Details

Telephone/mobile

Email

Date goods/service obtained *

Monetary value ($$$)

Complaint Details *

ADDITIONAL CONSUMER INFORMATION

Have you hired a lawyer?
YesNo

Have you complained to the Respondent?
YesNo

Do you understand the Council complaints handling procedures and options explained to you by the complaints officer?
YesNo

Do you understand that the Council does not promise nor guarantee a positive or successful mediation or complaints outcome?
YesNo

Do you understand that there are other agencies with enforcement powers who may/can assist you if need be?
YesNo

General Comments