Client Complaint Form
Note :
Prior to filing any complaint by using this form, we seek your kind consideration to reach out to our managers and allow our best effort to resolve your concerns and/or dissatisfaction with any specific area of our services.

In any circumstances where such endeavour is unsuccessful, you may submit your official complaint by filling in the information required in this form.

Complaint Particulars
Contractual Service

Management Service
Description of Service
Others (please state)
Description of Service
Description of Complaint
Date of Incident

Month Day Year
Date
Suggestion for Improvements
Name of Person-in-charge

First Name Last Name
Upon completion of this form, you may submit the form for escalation to the following authorised person:

To : The Principal Officer of Etiqa Offshore Insurance (L) Ltd

Name : Rosfadzilani Binti Ghani

Mailing Address : Etiqa Offshore Insurance (L) Ltd

Level 11B, Block 4 Office Tower

Financial Park Labuan Complex, Jalan Merdeka

87000 Labuan F.T. Malaysia

Email address: fadzilani.g@etiqa.com.my
I agree to Etiqa and/or its External Parties processing my personal data according to the Privacy Notice.
Auhtorised Signatory

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Name

First Name Last Name
Date

Month Day Year
Date
Should be Empty:

Client Complaint Form