Customer Complaint Form

Name: PH (HM): (MOB):
EMAIL: ADDRESS:
CURRENT STATUS: NEW APPLICANTEXISTING CUSTOMERGENERAL ENQUIRER YOUR COMPLAINT IS REGARDING? FDB’s SERVICEFDB’s PRODUCTFDB STAFFGCF PROJECT
IS THIS THE FIRST TIME YOU HAVE MADE THIS COMPLAINT? YesNo
If NO, please give details of when, where and to whom the complaint was reported to? Other efforts made to bring the issues to the attention of other grievance/redress mechanisms and whether relief, redress or other help was received.
ARE YOU LODGING A COMPLAINT ON BEHALF OF SOMEONE ELSE? YesNo
If YES, how are you related to the complainant? (Family, Friend, Legal Representative. Please provide details below – Name, relation & contact details. If legal representative – Name & contact details of company)
PLEASE PROVIDE DETAILS OF YOUR COMPLAINT BELOW.
(a description of the complaint, project or programme that has caused adverse impacts to the complainant, a description of how the complainants have been adversely impacted by the project or program, whether confidentiality is being requested and the reasons behind it, details of GCF policies and procedures or environmental and social safeguards that were violated.)