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General Complaint

Your Information so that we can contact you:

Type *

Complaint Type *

Your Name *

Civil Id Number: *

Mobile Number: *

Email:

Address:

The supplier of the product or service you are complaining about:

Region: *

Branch: *

Supplier name: *

Supp Registration No: *

Branch:

Phone No:

Email:

Location: *

Landmark: *

Details of your complaint:

Product/Service:

Brand Name:

Purchase Date:

Bill No:

Complaint Summary: *

Word verification: *

Attachment: