Complaint form as per Guidelines issued by CBB vide Circular no EDFIS/C/003/2018 dt 18/1/2018 with reference to “Section BC-4 Customer Complaints Procedures” of Business & Market Conduct Module of the CBB Rulebook ( 3)

Complaint Form – Insurance

Insurance Information


Claimant information:


Policyholder Info ( *if different than above)


Details & Nature of the complaints


What do you want the company to do?


How do you rate the customer service?