Consumer Protection Act, 2008 (Act No. 68 of 2008)

Notices

South African Automotive Industry Code of Conduct

Part B : Alternative Dispute Resolution

Schedules

Schedule 4 : Complaint forms

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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

Surname


First Names


Postal Address


Contact Details

Cell No


Home No


Work No


Fax No


e-mail




Preferred method of Communication

postal


e-mail


fax


Transaction Details





Representative's Name


Branch


Product Name


Reference


Date of Transaction / Incident


Summary of Complaint







Please attach all supporting documentation relevant to the complaint

COMPLAINT REGISTER AND PROGRESS REPORT

Company Name


Date Received

 

Complaint Handler


Complaint No

 

Company Representative


Designation

 

NAME OF CLIENT

 

Client Address

 

Client Contact Details

Cell

 

Home

 

Work

 

e-mail

 

Fax

 

COMPLAINT DETAIL

 

 

 

 

 

Complaint received by

Fax


E-Mail


Registered Post


Hand Delivered


Telephone


Other


Describe Other

 

Date Received

 

Date of Initial Response

 

Client Expectation

 

 

 

 

 

SUPPLY CHAIN

Are there any other parties in the supply chain involved?

Yes


No


Any evidence of 3rd party responsibility?

Yes


Has contact been made with the 31st party/ies?

Yes


No


No


Date Contacted

 

Confirmed in writing with supporting documents

Yes


No


Initial Response

 

Supply Chain Contact Details

Company Name


Contact Person

 

Tel No


Fax No


Cell No


e-mail


Website


Type

OEM


Retailer


Repairer


Sublet


Repairer

Sublet


Cleaner

Broker


Warranty


Administrator

VAP


Provider

Credit


Provider

Insurer


Other



Describe Other

 

SLA/Vendor Contract

Yes


No


Client Response

Acceptance


Rejection


Date


Reason for Rejection

 

 

 


Ombud Referral

Yes


Yes


Date


Outcome from Ombud

 

 

 

 

 

Final Result


Date


Date Finalised


Signed off by


TIME LINE IN RESPECT OF COMPLAINT HANDLING

CLIENT NAME






COMPLAINT NO






Date & Time


Contacted


Contact No


Comments

 

 

 

 

Date & Time


Contacted


Contact No


Comments

 

 

 

 

Date & Time


Contacted


Contact No


Comments