Consumer Protection Act, 2008 (Act No. 68 of 2008)NoticesSouth African Automotive Industry Code of ConductPart B : Alternative Dispute ResolutionSchedulesSchedule 4 : Complaint forms |
COMPLAINT NOTIFICATION FORM
DETAILS
| Attention: | The Motor Industry Ombudsman of South Africa |
| post: | Suite 156 |
Private Bag X025
Lynnwood Ridge, 0040
| Walk-in: | Building 14B |
CSIR Campus
Meiring Naude Drive
Pretoria East
| e-mail: | [email protected] |
| website: | www.miosa.co.za |
| telephone: | 086 11 MIOSA/086 11 64672 |
| fax: | 086 630 6141 |
| Date: |
Complainant's Details |
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Surname |
First Names |
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Postal Address |
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Contact Details |
Cell No |
Home No |
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Work No |
Fax No |
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Preferred method of Communication |
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Transaction Details |
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Representative's Name |
Branch |
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Product Name |
Reference |
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Date of Transaction / Incident |
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Summary of Complaint |
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Please attach all supporting documentation relevant to the complaint |
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COMPLAINT REGISTER AND PROGRESS REPORT |
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Company Name |
Date Received |
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Complaint Handler |
Complaint No |
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Company Representative |
Designation |
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NAME OF CLIENT |
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Client Address |
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Client Contact Details |
Cell |
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Home |
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Work |
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Fax |
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COMPLAINT DETAIL |
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Complaint received by |
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Describe Other |
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Date Received |
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Date of Initial Response |
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Client Expectation |
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SUPPLY CHAIN |
Are there any other parties in the supply chain involved? |
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Any evidence of 3rd party responsibility? |
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Has contact been made with the 31st party/ies? |
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Date Contacted |
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Confirmed in writing with supporting documents |
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Initial Response |
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Supply Chain Contact Details |
Company Name |
Contact Person |
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Tel No |
Fax No |
Cell No |
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Website |
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Type |
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Describe Other |
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SLA/Vendor Contract |
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Client Response |
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Date |
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Reason for Rejection
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Ombud Referral |
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Date |
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Outcome from Ombud |
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Final Result |
Date |
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Date Finalised |
Signed off by |
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TIME LINE IN RESPECT OF COMPLAINT HANDLING |
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CLIENT NAME |
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COMPLAINT NO |
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Date & Time |
Contacted |
Contact No |
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Comments |
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Date & Time |
Contacted |
Contact No |
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Comments |
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Date & Time |
Contacted |
Contact No |
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Comments |
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