Complain Entry


Complaint:      
Name: CNIC:[13 OR 11 Digits]:
Address: E-mail(for email updates about your complain):
City:    
Phone No:    
Fax:    
Mobile No.(for free SMS updates about your complaint):
     
Complaint Against :    
Company Name: Employee Designation:
Date of Complaint: Nature of Claim :
Brief of Complaint: Amount Involved:
Amount of Premium Place of Incident
Date of Insurance Policy Copy of Insurance Policy
Survey Report (If any)   Reason of Repudiation(Optional)