Client Complaint/Feedback Form

What would you like to complain / feedback?

Complain

Feedback

Name * This field is required.To solve your complaint effectively, we need your full name.

Gender

Male

Female

Address* This field is required.

Phone number* This field is required.

Are you Maxima's existing/old customer?* This field is required.

Yes

Which product do you use?* This field is required.

Individual Loan

Group Loan

ME Loan

M-Bela Loan

What would you like to complaint/feedback?* This field is required.

Products

Services

Compensation

Staff Behavior

Suggestion

Others

Choose how you want to leave complaint or feedback?* This field is required.

Voice recording

Type written

Please provide details or description of your complaint/ feedback, example date of service/ incident.* This field is required.

You can also leave your voice here* This field is required.

You can upload any proofs/documents here ( If any)

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

Confirmation* This field is required.

I hereby confirm that all information given are true and correct

Complaint/ Feedback Ticket No.(Hide)

Complaint/ Feedback Ticket No.* This field is required.Please take a screenshot of the summary of your Complaint/Feedback as for your record

Would you like to receive a receipt of your complaint or feedback, complaint form, and notification of solution letter?* This field is required.If you choose 'No', you agree to keep your complaint receipt, complaint form and notification of solution letter with MAXIMA

Yes

Preferred contact info to receive a receipt of your complaint or feedback, complaint form, and notification of solution letter about this complaint/feedback** This field is required.This can be E-mail/ Facebook User link, Telegram, etc. If you do not have a preferred contact info, we will deliver a receipt of your complaint or feedback, complaint form, and notification of solution letter to your house.

Client Complaint/Feedback Form