Dispute resolution solutions

Complaint Form :

For a business-to-business or interpersonal dispute, please contact us for details
of the process and costs. Email: info@onlineombud.com

Complete and send complaint form online fill out the form fieds below

How do we reach you?

Please complete all boxes:

2. If a complainant is a business:

Partnership Company Close Corporation Trust Association

Full Business Name : (full legal name/s)

Full name of representative :

Capacity of representative :

Postal Address :

Contact Information:

Tel Work: Fax:

Tel Home: Mobile:

Email Address: (compulsory)

Repeat Email :

Id No:

Reg No:

Name of preferred contact person:

Preferred contact person's Email Address:

Tell us your complaint...

Name of business you are complaining about:

Branch of business:

Your account number if applicable:

Type of product / service you are complaining about :

Business website:

Business email address:

Business Phone : extension

How much did you pay the business?

Did you file a dispute with the business? Yes No

Did you file a dispute with the business more than 21 days ago? Yes No

Explain your problem: Please only set out the relevant facts including dates, times, places and names.

Failure to complete this section fully may lead to a delay in the processing of your complaint.

What i/we want from the business:

Briefly state what outcome you hope to achieve. (e.g. I would like to refund / reverse amount etc)

Confirmation of Jurisdiction and Undertaking:

If the complaint is brought by a business under the National Credit Act, I confirm that the annual turnover / net assets of my business does/ do not exceed R 1 000 000: (Please tick to verify)

I confirm that my complaint is or has not been: (Please tick to verify)
the subject of any legal proceedings. If I have consulted an attorney it has been only to get advice or assistance in drafting my complaint;

dealt with by a dispute resolving body / arbitration;

By submitting this form I agree to be bound by the Onlineombud complaint process and procedures.

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