Complaint Form

COMPLAINT FORM

Section: 1 – COMPLAINANT’S DETAILS (Only complete this section if you are complaining on behalf of another person.)
Name: / Surname:
Identity number: / Relation to the claimant:
Telephone number: / Alternative number:
Email address: / Postal Address:
Physical Address (if not the same as postal):
Is this complaint accident related? / YES/NO
Have you lodged your complaint with other institutions? / YES/NO / If Yes, state where:
Section: 2 – CLAIMANT’S DETAILS (Only complete this section if you are not the injured.)
Name: / Surname:
Identity number: / Relation to the injured:
Telephone number: / Alternative number:
Email address: / Postal Address:
Physical Address (if not the same as postal): / Claim
Reference and Branch (if known):
Section: 3 – INJURED’S/DECEASED’S DETAILS
Name: / Surname:
Identity number: / Relation to the claimant:
Telephone number: / Alternative number:
Email address: / Postal Address:
Physical Address (if not the same as postal): / Claim
Reference and Branch (if known):
Have you lodged your complaint with other institutions? / YES/NO / If Yes, state where:
Section: 4 – Please give a detailed description of your complaint

DATE: ------

SIGNATURE: ------

Kindly submit completed form, to the RAF, by email () or by fax (0878098860)

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