ANGUILLA ELECTRICITY COMPANY LIMITED (ANGLEC) Consumer Complaint Report
Form No: I _ _ _ _
000/I _ _ _ / _ _
Complaint No: _________________ ACKNOWLEDGEMENT OF COMPLAINT Date: _________________ 1. Complainant's Name 2. Complainant's Address 3. Complainant's Phone No. 4. Complainant's Account No. 5. Details of Complaint (a) Location of Occurrence (b) Nature of Occurrence (c) Date of Occurrence (d) Time of Occurrence (e) Any Additional Information Home: Office:
6. Complainant's Signature ___________________________ FOR OFFICE USE ONLY Complaint Taken By (Print) Date: ____________________
Date ________________
Signed: ______________________________ Time: _______________________________