Choose your organisation from the following list of options.

Customer (Complainant) Details

Who is the complaint being lodged for. This could be the Insured, a third party or Primary contact of the claim or policy.

First name of who the complaint is being lodged for (i.e. the Insured, a third party or Primary contact of the claim or policy). If the policy or claim is held in a Business name, ensure you include this in the Complaint description field.

Last name of who the complaint is being lodged for i.e. the Insured, a third party or Primary contact of the claim or policy.

Small Business is classed as a business with less than 100 staff.

Customer (Complainant) Preferred Contact Method *

Only one preferred contact method for the complainant entered above is required. Preference is for phone or email to avoid delays in responding.

Complaint Details

Provide as much detail about what the complaint is about. Note that if the claim or policy is held in a Business name, include the Business name in the Complaint description field.

Choose what the complaint relates to. If the complaint relates to the customer’s   claim, choose claim. If the complaint is in relation to the customer policy or      product, choose policy/product.

Insert customer’s Product or Policy number the complaint relates to. Ensure you provide the correct policy or product number details.

Insert customer’s Claim number the complaint is related to. Ensure the correct claim number details are provided.

Choose which type of insurance product the claim or policy relates to.

Complaint Description *

Desired Outcome *

External Party Details (Enter your details)

Person lodging the complaint on behalf of the complainant.

Choose the option that most appropriately describes your relationship to complainant and complete the required information.

Manage Communication With Customer *
Choose whether you will manage the ongoing communication with the Customer regarding this complaint

Ensure you provide a valid email address for acknowledgement of complaint submission.

If you are a Broker lodging the complaint you must indicate the state you are from.

Complaint Description

Provide a detailed description about the complaint, taking note:

  • If the claim or policy is held in a business name, please include it here.
  • If the complainant is not the policy holder.
  • If the complainant requires the additional assistance of an interpreter (include preferred language).
  • If the customer requires additional support due to personal circumstance (indicate the type of support required). Customer may require support due to, (but not limited to), financial, mental, physical, domestic violence situations.

Desired Outcome

Include a detailed description of the outcome the customer is seeking. If the complaint has already been resolved with the complainant, please include summary of how the complaint was resolved and the outcome provided.