Let’s grow Together
Skip to navigation
Skip to content
About
Our Work
Service
Training
Certificate
Blog
Contact
About
Our Work
Service
Training
Certificate
Blog
Contact
Complaint
Form Complaint
{"field_dedec74":{"display_mode":"show","fire_action":"All","file_types":"png","logic_data":[{"cfef_logic_field_id":"conditional_radio_trigger","cfef_logic_field_is":"==","cfef_logic_compare_value":"Yes","_id":"4363aec"}]},"field_be14ce2":{"display_mode":"show","fire_action":"All","file_types":"png","logic_data":[{"cfef_logic_field_id":"conditional_radio_trigger","cfef_logic_field_is":"==","cfef_logic_compare_value":"Yes","_id":"e7595e8"}]},"field_7435a02":{"display_mode":"show","fire_action":"All","file_types":"png","logic_data":[{"cfef_logic_field_id":"conditional_radio_trigger","cfef_logic_field_is":"==","cfef_logic_compare_value":"Yes","_id":"a2c45cc"}]},"field_7b95416":{"display_mode":"show","fire_action":"All","file_types":"png","logic_data":[{"cfef_logic_field_id":"conditional_radio_trigger","cfef_logic_field_is":"==","cfef_logic_compare_value":"Yes","_id":"fdc8f37"}]},"field_6b213cc":{"display_mode":"show","fire_action":"All","file_types":"png","logic_data":[{"cfef_logic_field_id":"conditional_radio_trigger","cfef_logic_field_is":"==","cfef_logic_compare_value":"Yes","_id":"62f3067"}]},"field_00e87c2":{"display_mode":"show","fire_action":"All","file_types":"png","logic_data":[{"cfef_logic_field_id":"field_449c422","cfef_logic_field_is":"==","cfef_logic_compare_value":"Yes","_id":"98e3d1b"}]},"field_0c66d8a":{"display_mode":"show","fire_action":"All","file_types":"png","logic_data":[{"cfef_logic_field_id":"field_449c422","cfef_logic_field_is":"==","cfef_logic_compare_value":"Yes","_id":"c3e08cc"}]},"field_70d9167":{"display_mode":"show","fire_action":"All","file_types":"png","logic_data":[{"cfef_logic_field_id":"field_449c422","cfef_logic_field_is":"==","cfef_logic_compare_value":"Yes","_id":"94b2419"}]},"field_86a6cec":{"display_mode":"show","fire_action":"All","file_types":"png","logic_data":[{"cfef_logic_field_id":"field_fd7e17c","cfef_logic_field_is":"==","cfef_logic_compare_value":"Yes","_id":"cf81f7d"}]},"field_dbac9f7":{"display_mode":"show","fire_action":"All","file_types":"png","logic_data":[{"cfef_logic_field_id":"field_fd7e17c","cfef_logic_field_is":"==","cfef_logic_compare_value":"Yes","_id":"edd44e9"}]},"field_ec8945f":{"display_mode":"show","fire_action":"All","file_types":"png","logic_data":[{"cfef_logic_field_id":"field_dbac9f7","cfef_logic_field_is":"==","cfef_logic_compare_value":"Other","_id":"083ffe5"}]}}
Title
First name
Family name
Date of birth
Postal address
State
Postcode
Mobile phone
Daytime phone
Email
Are you lodging the complaint on behalf of business?
Yes
No
What is your relationship to the business? e.g. owner, employee
Business name:
ABN:
Number of employees the business had at the time of the event(s) giving rise to the complaint:
Is the business a primary producer?
Yes
No
First name
Title
Family name
Organisation name
Relationship to you
Postal address
Postcode
State
Daytime phone
Email
Name the financial firm you have a complaint with:
Have you made a complaint to this financial firm?
Yes
No
If so, when did you complaint to the financial firm?
How di you make yourcomplaint?
Since you make complaint, have you received a final response in writing?
Yes
No
What short of product or service is the complaint about?
Financial firm reference numbe(s) if available:
What is your compalint about?
When did the events you are compalining abaout happen?
What do you think is afair and reasonable resolution to the compalint?
Has your financial firm commenced legal proceedings againt you in a court?
Yes
No
Additional assistance
Yes
No
Languange
Is there any additional assitance we can provide?
Cognitive condition
Physical impairment
Family violence
Sight/vision
Hearing
Text telephone
Literacy
Mental health
Other
How did you hear about AFCA?
I already knew about AFCA
Finacial firm
Community organisation
Legal Aid/community legal centre
Family/friend
Media/advertising
Finacial counsellor
Online/socaial media
Working together to resolve the complaint
I understand and agree to follow the behaviour expectations set out in the Engagement Charter during AFCA's dispute resolution process.
Documet Checklist - this list is provide as a guide
Completed and signed complaint form
Copy of Statement of Claim
Copy of writen response from your finacial firm (if applicable)
Copy of any other document relevant to your complaint
Kirim
About
Our Work
Service
Training
Certificate
Blog
Contact
About
Our Work
Service
Training
Certificate
Blog
Contact
Type to search
Search for:
Terima Kasih
Formulir telah berhasil terkirim
Hello!
Can I help you?
CEO
Dedi Priyanto
Support
Saiful Amri
Support
Tryas Arfidini
chat