Complaint form ABN

Transcription

1 Complaint form ABN Use this form to tell us about your complaint. We will use the information you give us to investigate your complaint. Do you hold your account with another person? If you applied for the financial product together with another person, they will need to fill out their details on page 2. If they cannot do this, please let us know in your complaint summary (page 5). Do you need help filling out this form? If you need us to help you to fill out this form, you can call us on (9.00am 5.00pm Monday to Friday AEST (excluding public holidays)). Do you want another person or company to handle this complaint for you? If you would like someone else to represent you, fill out the third party authority (page 2). Lodging this form You can send the completed form to: E: F: P: Reply Paid 252 South Sydney, NSW 1234 If you prefer, you can fill out and lodge your complaint online at te In accordance with the Credit and Investments Ombudsman Rules, all statements you make and information or documents you provide us are on a without prejudice basis. This means that nothing you say or do or information you give us during this process can be used later in legal proceedings, unless required by an appropriate court process. Version 18.2 Page 1

2 Your name and contact details Main consumer Mr / Ms / Mrs / Miss / Mx (please circle) Second consumer Mr / Ms / Mrs / Miss / Mx (please circle) First name Last name Date of birth Postal Address address Main telephone number Alternative telephone number Preferred method of contact Post Post (Optional) Do you identify as: (Please tick any that are relevant) Do you need any special assistance with your complaint? (Please tick any that are relevant) Do you need an interpreter? If YES, which language? Aboriginal Torres Strait Islander Hearing Vision Physical Speech Other: Aboriginal Torres Strait Islander Hearing Vision Physical Speech Other: Third party details Please fill out this form if you want another person or company to represent you in managing this complaint. If you complete this form, we will send all correspondence to the person you have nominated, and not to you. If we cannot get in contact with that person, we may contact you using details that you gave above. Organisation name Contact name Postal address address Telephone number Version 18.2 Page 2

3 Details of the product/service you received What is the name of the person or business you are complaining about? What type of product did the person or business provide to you? Mortgage Personal loan Financial advice Credit card Lease t sure Other: What was the main purpose of this product? Personal Business Investment Other: Name/s on the account: If there is more than one account holder, please provide their details on page 2. Account or customer reference number: Are you lodging this complaint on behalf of your business? Name of your business How did you hear about us? Person or business you are complaining about Financial counsellor Community legal centre/ Legal Aid ASIC Financial Ombudsman Service (FOS) Other Ombudsman Internet search Credit repair company Word of mouth Lawyer private Other: Version 18.2 Page 3

4 Complaint summary When did you first realise there was a problem? Have you asked the person or business you are complaining about to fix the problem? If YES, approximately when? Did the person or business respond to your complaint? If YES, approximately when? Describe your complaint. Tell us: what happened, when it happened, who you think is responsible. How would you like your complaint to be resolved? If you need to send us documents that support your claim, do not send us the original documents please send us photocopies of the originals. Supporting documents may include agreements, loan documents, application forms, broker contracts, s, telephone records, statements of advice, etc. Version 18.2 Page 4

5 Privacy statement This privacy statement outlines how we will handle your personal information. To investigate the complaint you have made to us, we will need to collect and use your personal information. This means that we will collect information about you, or the complaint, from any or all of the following: 1. you or any representative you nominate, 2. the person or business you are complaining about, their licensee and/or their representative, and 3. another external dispute resolution scheme approved by the Australian Securities and Investments Commission (ASIC) or the Office of the Australian Information Commissioner (OAIC). We need to collect information about you or the complaint to review and investigate your complaint, as well as any related potential systemic issues or serious misconduct. Without this information, we may not be able to conduct a proper investigation. As part of our normal activities, we may also disclose information about you: 1. to the person or business you are complaining about, their licensee and/or their represenative. This information may be disclosed overseas if the person or business is located overseas. To find out whether this applies to your complaint, please search our online directory, 2. to a government or regulatory authority such as ASIC or OAIC, 3. to another ASIC or OAIC-approved external dispute resolution scheme, and 4. in accordance with compulsory legal process such as a court subpoena. We do not engage in direct marketing activities and will not provide your personal information to anyone for that purpose. Privacy Policy Further information about our privacy obligations can be found in our privacy policy, including how you can: access the personal information we hold about you, ask us to correct any personal information we hold about you, and make a complaint about a breach of your privacy, and how we will deal with such a complaint. A copy of our full privacy policy is available at or by calling us on Acknowledgment By signing this form, you acknowledge that: the information you have provided in this form is correct, you have authorised us to contact your nominated third party to respond to your complaint on your behalf (if applicable), and you have read and understood our privacy statement (above). Name Signature Date Main consumer Second consumer Signature Name Date Company consumer (if applicable) Director / Sole Director and Secretary Director / Secretary Version 18.2 Page 5