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

    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.

    Applicant details

    Dispute details

    Additional Comments

    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.

    Verification

    Example: 12

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