National Consumer Commission

Form - Complaint
Full names of complainant
ID number of complainant
Postal Address
Physical Address

Cell phone number

Landline number
Fax number
E-mail address
Has the complainant previously
filed a complaint with the NCC?
If so, please provide the reference
number
Nature of complaint
Name of company (supplier)
Address of company against
whom complaint is made

Company Landline number

Company Fax number
Company E-mail address
Details of complaint

Details of steps taken to resolve

the complaint

1.
Cell phone number
2.
Landline number
3.
Fax number
4.
E-mail address
5.
Nature of complaint :
CATEGORY
TICK
Retail
Motor Vehicles
Cell phones
Property
Financial Services
Government
&
Municipalities
Telecommunications
List of documents relevant to
Fitness Centres
complaint
attached
Time
Share to this form
Medical Services
Travel & Tourism
What outcome
do you propose for
Education
Computers
this complaint?
Accessories
Date
Place Others
Signature

&

6. Name of company (supplier)

7. Address of company (supplier)
Company(supplier) Landline number
Office use8.only
9.
Company (supplier)Fax number
Reference number
10. Company(supplier) E-mail address
TC
11. Detailed complaint written in full.

HECKLIST
1.
Full names of
complainant
2.
ID number of
complainant
3.
Physical
Address
of
complainant