THE OMBUDSMAN FOR LONG-TERM INSURANCETHE OMBUDSMAN FOR LONG-TERM INSURANCE

SUBMIT A DISPUTE

SUBMIT A DISPUTE

I/We do hereby apply for the Ombudsman for Long-Term Insurance to investigate and consider the dispute with my/our insurance company. All relevant correspondence or documentation is attached.


PARTICULARS OF COMPLAINT

Complainant’s details:

Title
Surname
Initials
Postal Address
Code
Tel
Fax
E-Mail Address
Policy Holder's Full Name
Policy Holder's ID
Policy No
Type of Policy
Name of Insurance Company Involved
DETAILS OF COMPLAINT

Would you kindly set out legibly all the facts which you consider have a bearing upon this complaint; including dates, places and names.


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