DETAILS OF COMPLAINT
Please note: Failure to fully complete this section may lead to a delay in the processing and/or return of your complaint.
Set out your complaint below, stating only the relevant facts, including dates, times, places and names. Please write in block letters, preferably in black ink. Should this form, however, fail to provide enough space, you may write down or type out the details of your complaint on a separate sheet of paper and attach it to this form.
Attach copies of all documents supporting your complaint. We cannot, unfortunately, take the responsibility for the loss or return of any original documents.
N.B. Please summaries your complaint in the space below, even if you have submitted a detailed version of your complaint to us or provided us with documents explaining the complaint.
What I / we want from the Bank
Briefly state what outcome you hope to achieve. (For example: I would like the Bank to refund/reverse the amount of P----.)
I have applied to the Office Of The Banking Adjudicator because (please make a cross in A or B) (Please attach a copy of the rejection letter, if any.)
I hereby confirm that the annual turnover of the business (or group of companies, if a part thereof), trust or association that I represent is approximately P3 Million or less).
Rules and undertaking
a) The office offers a service to bank clients to resolve their complaints through mediation or by making a recommendation or determination. This service, however, is not the same as that rendered by an attorney and the office does not give legal advice. I agree, therefore, not to hold the Office Of The Banking Adjudicator or any of his/her staff members liable for any loss or damage - whether contractual, owing to a delict or of any other nature - that I may suffer as a result of the Office accepting and dealing with my complaint .
b) The service provided to clients by the office is free: no charge can be claimed from me for this service (subject to matters referred for review), nor can anyone charge a fee for supplying me with an application form. I understand that it is not necessary to consult any professional person or body and that the office shall guide me through all the procedures.
c) I understand that I am entitled to withdraw my complaint or to institute legal action at any time while my complaint is being investigated by the Office Of The Banking Adjudicator . If I were to make such a decision, I would inform the Office Of The Banking Adjudicator thereof in writing.
d) If, as a result of lodging this complaint with the Office Of The Banking Adjudicator, I were to accept an amount of money from the Bank in settlement of my claim, I would have no right to claim further amounts from the Bank in respect of the complaint. The amount accepted by me would be in full and final settlement of my claim.
e) The Office Of The Banking Adjudicator may dismiss my complaint if I fail to provide information when requested or if I fail to reply to letters from the office within a reasonable time or if I were vexatious, abusive or insulting when communicating with the office. The Office Of The Banking Adjudicator has the sole right to decide whether or not I have been vexatious, abusive or insulting.
f) I understand that the process of investigating my complaint will take time. The office will inform me in writing of the progress of my complaint. I agree not to telephone the office about my complaint. Should I wish to find out how my complaint is progressing or should I want to communicate with the office for whatever reason, I will do so in writing.
g) I understand that the Office Of The Banking Adjudicators' decision is final regarding the following matters: i) Whether or not my complaint comes within the jurisdiction of the office. ii) Whether or not the Bank is at fault. iii) The amount of money that the Adjudicator believes the Bank should pay me if my complaint were resolved in or partially in my favour .
h) I acknowledge that, during or after the investigation of my complaint, it may emerge that the matter is very complicated, involving many complex legal issues or requires oral evidence by witnesses. I, therefore, agree to any decision the office may make to cease any investigation or to recommend that the complaint be dealt with in a more appropriate forum.
i) I understand that if I were dissatisfied with the final determination of the Adjudicator, I would have a right to apply to the review panel for a review of the decision(subject to certain conditions). At any time I can however withdraw the complaint and pursue the matter through other channels.
j) I understand that I may be legally obliged to continue making payments regarding any debt owed by me to my Bank, and that I should seek independent legal advice before stopping such payments.
k) I acknowledge that I may not publish any of the details of my complaint in any form of media and that the Ombudsman may, in his/her sole discretion, decline to continue any investigation if, in his/her opinion, such publication were detrimental to the investigation in any way.
l) Confidentiality a greement My complaint and the documents I submit to the office shall be deemed confidential. The letters and documents sent to the office by the Bank
Should my complaint be the subject of a court case or any other dispute-resolving process, neither my representative nor I will subpoena the documents in my file or the Adjudicator or any member of his/her staff. Neither my representative nor I will order that any of these documents be discovered in terms of any rules of court.
I hereby authorise my Bank to disclose any information it may have that the Office may require to investigate my complaint.
By my signature below, I hereby agree that my complaint be dealt with by the Adjudicator on the above terms and conditions and according to the rules of the office. The information provided by me in this form is, to the best of my knowledge, true and correct. I understand that the submission of a false claim may constitute the crime of fraud.