Dispute Resolution Form

Before the Financial Commission can consider your dispute, you need to have complained to the financial services provider and given it an opportunity to resolve your dispute. In most cases, it has 14 days to respond.

Action to date

Have you previously lodged or ‘registered’ this dispute with us?: Yes, I have previously lodged or registered this dispute with the Financial Commission.No, this is the first time I have lodged or registered this dispute with the Financial Commission.If Yes, The case number is

Applicant details

Title:

First Name: *

Middle Initial: *

Family Name: *

Country of Residence: *

Phone Number: *

Email: *

Dispute details

Name of the financial services provider you have a dispute with:

Please provide a reference number so that your financial services provider can locate the correct information:

Please describe the nature of your complaint. Please include as much information as you can,including the type of product involved, the dates the problem occurred, the name, address and telephone number (if you know these) of all individuals and firms involved and a description of the problem (please attach a separate page if you need more space than provided)

Additional Comments

What do you think is a fair and reasonable resolution to the dispute? If you are seeking payment of a sum of money please provide any relevant calculations of your claim(s)

Supporting documents

Instructions

Please attach copies of all documents you have that relate to your dispute. If your financial services provider has written to you about your dispute, please ensure that you provide a copy of its response.

File Upload

Verification

Please enter any two digits *

Example: 12

Resolve Dispute

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