TPB CITIZENS CHARTER - FEEDBACK FORM

TPB CITIZENS CHARTER - FEEDBACK FORM
Please let us know how we have served you. This form may be used for compliment, suggestion and/or complaint.
Name *

First Name Middle Initial Last Name
Date *

Month Day Year
Email Address *
Age *
Sex *

Male Female
Address *
Telephone/ Mobile Number *
Title/Purpose of Transaction

Processing of Payroll Processing of Claims and Payment Request for Certification and Service Record Recruitment, Selection and Promotion Procedure Request for Certificate of No Pending/With Pending Administrative Case TPB Membership Program
Person/Unit/Office Transacted with: *

Part II: Customer Feedback
1. Please check if you are providing a commendation, suggestion or complaint: *

Commendation Suggestion Complaint
2. Facts or details of the situation/Incident *
Recommendation/Suggestion/ Desired Action from Office *
I consent to the collection, generation, use, processing, storage, and retention of personal data by TPB for the purpose/s described above.

I also authorize TPB to disclose my information to accredited/affiliated third parties or independent/non-affiliated third parties, whether local or foreign, when the use or disclosure is reasonably necessary, required or authorized by or under the law; and as needed for the proper execution of processes related to the above-mentioned declared purposes.
Should be Empty:

	5	4	3	2	1
1. How would you rate your OVERALL SATISFACTION with regard to the quality of service delivery?
2. How satisfied were you in terms of the response time to your transaction given by the office?
3. How satisfied were you with the outcome of the service provided?
4. How satisfied were you with the service provider’s extensive information on /understanding of the service being provided?
5. How satisfied were you with the service provider’s competence or the skill in delivering the service?
6. How satisfied were you with the service provider’s friendliness, courteousness/politeness, fair treatment and willingness to do more than what is expected or going the extra mile?

Part I: Customer Satisfaction Rating