Sample Complaint Register Template

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Sample Complaint Register Template Powered By Docstoc
					                                Sample Complaint Register Template


Complaint #                                                            Date received

                                                      Medium (phone/letter/fax/        Date
Time received               Received by
                                                      e-mail/in-person)                acknowledged




                                          CUSTOMER INFORMATION
                                                                                       Account
                                                      City, Prov.,
Complainant's Name          Address                                   Phone            /Policy/
                                                      Postal Code
                                                                                       Customer #




E-Mail Address

                                             COMPLAINT DETAILS
Date problem
occurred
                            Business line?            Product or service?              Person/dept.?
Complaint concerns
which:


Nature of complaint:




What customer wants done:




Outcome (e.g., agreement reached, partial agreement, no agreement, referred, declined, withdrawn)




Date of final position letter to client               Approved by/signature