A sample complaint form can be used to record a grievance experienced either by a consumer or employee. It enables you to document the complaint for future reference especially in case of a lawsuit. This form can be used as an example of the kind of format used in such documents.
Name of complainant: _____________________________________________________
Address: ________________________________________________________________
Tel: ____________________________________________________________________
Mobile: _________________________________________________________________
Email: __________________________________________________________________
Name of the accused: ______________________________________________________
Address: ________________________________________________________________
Position: ________________________________________________________________
Tel: ____________________________________________________________________
Mobile: _________________________________________________________________
Email: __________________________________________________________________
Describe the nature of your complaint: ________________________________________
____________________________________________________________________
Date of complaint: ________________________________________________________
Give details of those involved in your complaint:
Name Position Describe their involvement
____________________ ____________________ ________________________
____________________ ____________________ ________________________
____________________ ____________________ ________________________
____________________ ____________________ ________________________
____________________ ____________________ ________________________
Describe any actions that can be taken following your complaint: ________________
__________________________________________________________________
Any additional comments: ______________________________________________
__________________________________________________________________
Complainant’s signature: ____________________________ Date: _____________
By signing you declare all information given is accurate and truthful.
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