Complaint Form
Please provide the following details to your request
Name of Client
*
First Name
Last Name
Policy Number
Date of Birth
*
-
Day
-
Month
Year
Date
Phone Number
*
Format: 0000000000.
Email
Please provide your email address
Complaints Types
*
Arrears-Deduction-without-Client-Knowledge
CAGD-Affordability-Locked
Claim-Amount-Discrepancies
Continuous-Deductions-after-Cancellation
Cycle-Change
Death-Claim-Repudiation
Delays-in-Benefit-Payment
Dispute-over-T&C
General-Premium-Increment
Lumped-Premium
Merged-Policies
Mis-selling
Non-Deductions-of-Premiums
Over-Deductions
Paid-Benefit-not-Received
Phone-not-Answered
Policy-Start-without-client-Notice-of-Acceptance
SMS-Alert-not-Received
Suspected-Fraud-Cases
System-Issues
Unallocated-Premium
Under-Deduction
Unhandled-Client-Request
Update-not-effective
Wrongful-Allocation
Wrongful-Deductions
Complaints Details
*
Non policy holder
Please provide more information
Non policy holder details
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*
ABSA (GH) LTD
ACCESS BANK GHANA LTD
AGRICULTURAL DEVELOPMENT BANK
APEX BANK
BANK OF AFRICA
BANK OF GHANA
BSIC BANK GHANA
CAL BANK LTD
CONSOLIDATED BANK GHANA
ECOBANK GHANA LTD
FIDELITY BANK GHANA
FIRST ATLANTIC BANK LTD
FIRST BANK NIGERIA
FIRST NATIONAL BANK
GCB BANK LTD
GHL BANK
GUARANTY TRUST (GH) LTD
NATIONAL INVESTMENT BANK
OMNI BANK GHANA LTD
PRUDENTIAL BANK LTD
REPUBLIC BANK (GH) LTD
SOCIETE GENERAL GHANA LTD
STANBIC BANK GHANA LTD
STANDARD CHARTERED BANK
UNITED BANK FOR AFRICA (GH) LTD
UNIVERSAL MERCHANT BANK (GH) LTD
ZENITH BANK
Account Holder Name
*
Account Number
*
Branch Name
*
Supporting Documents
Browse Files
Please upload any supporting documents
Cancel
of
Incidence Branch
Advantage Place
High Street
Industrial Area
Spintex
Nima
Airport
Weija
Madina
Tema
Kpong
Ho
Hohoe
Koforidua
Nkwakwa
Cape Coast
Akim Oda
Takoradi
Tarkwa
Kumasi-Ahodwo
Kumasi-Amakom
Mampong
Obuasi
Sefwi-Wiawso
Sunyani
Techiman
Goaso
Tamale
Bolgatanga
Wa
National ID Type
*
National ID
National ID Number
*
Please upload National ID
*
Browse Files
Please take a photo of your National ID
Cancel
of
TIN Number
Taxpayer Identification Number (TIN)
Sign your Signature
*
Submit
Profile Status
Select Bank
*
ABSA (GH) LTD
ACCESS BANK GHANA LTD
AGRICULTURAL DEVELOPMENT BANK
APEX BANK
BANK OF AFRICA
BANK OF GHANA
BSIC BANK GHANA
CAL BANK LTD
CONSOLIDATED BANK GHANA
ECOBANK GHANA LTD
FIDELITY BANK GHANA
FIRST ATLANTIC BANK LTD
FIRST BANK NIGERIA
FIRST NATIONAL BANK
GCB BANK LTD
GHL BANK
GUARANTY TRUST (GH) LTD
NATIONAL INVESTMENT BANK
OMNI BANK GHANA LTD
PRUDENTIAL BANK LTD
REPUBLIC BANK (GH) LTD
SOCIETE GENERAL GHANA LTD
STANBIC BANK GHANA LTD
STANDARD CHARTERED BANK
UNITED BANK FOR AFRICA (GH) LTD
UNIVERSAL MERCHANT BANK (GH) LTD
ZENITH BANK
Account Holder Name
*
Account Number
*
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