Customer Complaint Form

  1. This form is filled by Complainant
  2. Complete this complaint request form
  3. Once done, this form will be submitted to complaint handling division
  4. This complaint form shall be submitted with a copy of the complainant’s ID card
  5. The original letter of power of attorney must be attached if the complaint is being authorized by policy holder
The (Re)Insured agree that any communication, information collected or held by the (Re)Insurer whether contained in the application or otherwise obtained may be used and disclosed to the (Re)Insurer’s associated individuals/companies or any independent third parties (within or outside Indonesia), which parties are bound by confidentiality obligation and/or which has signed a confidentiality agreement with (Re)Insurer, for any matters relating to the (Re)Insured application and any policy issued, in order to provide advice or information concerning products, claims and policy servicing as well as to provide services to the (Re)Insured related with (Re)Insured’s policy.

    

Customer General Information

   

** The original letter of power of attorney must be attached if the complaint is authorized by policy holder / Insured / Beneficiary

Complaint Category
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