Your complaint is really important to us. Please fill in the form below then submit.

	COMPLAINANTS DETAILS
Full Names:
Email Address:
Phone:
City/Town:
Nature of Business or if Personal/Individual:
	SERVICE PROVIDER DETAILS
	(Please indicate details of the service provider you are complaining about)
Name of Organization
Email Address:
Phone:
City/Town:
Nature of Business:
Type of Complaint:	---Please select complaint type--- Billing Disputes High Tarrifs Service Interaption Quality Of Service Service Provisioning Delays False And Misleading Advertisments Intrusion Of Privacy Health And Saftey Poor Customer Service Access To Emergency Services Access To Customer Care Services
Nature of the Complaint:
Have you exhausted the complaints mechanism provided by your service provider?:	Yes No
	(If No, kindly forward your complaint to your service provider)
If Yes above, Kindly indicate date you reported complaint to your service provider, reference number given by your service provider and the remedy sought:
	COMPLAINANT DECLARATION
Declaration:	I / We hereby declare that the information provided is true
Verification Code: