Complaints Form – Client Mandate & Terms of Business

Complaints Form – Client Mandate & Terms of Business

Please provide your contact details and describe your complaint so we can assist you.
Please read and check each box below to acknowledge your agreement before signing.
Full Name & Surname

First NameLast Name
Client Name
Email Address
example@example.com
Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
South African ID / Passport Number
Physical Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Who is the other party or authority involved in this dispute?
Other Please Specify
Briefly describe the nature of your complaint:
Statutory Compliance & Legal Disclaimers
Statutory Compliance & Legal Disclaimers

1. Legal Status & Disclaimer Acknowledgment. I explicitly acknowledge and agree that Complaints Authority SA (PTY) LTD is a private dispute resolution consultancy. It is not a law firm, nor does it provide legal representation or legal advice. I understand that: Services are strictly limited to administrative dispute processing, factual file analysis, procedural guidance, consumer rights advocacy, and document preparation. No communication or material received from the company constitutes formal legal counsel. If I require formal legal representation, I must consult a registered legal practitioner independently.2. Sector Scope, Limitations & Liability Waiver. I understand that Complaints Authority SA assists with administrative dispute processing across various sectors involving suppliers, landlords, employers, and contractors. I explicitly acknowledge that: Jurisdiction: Final determinations rest entirely with independent statutory bodies, tribunals, or Ombuds (including but not limited to the Rental Housing Tribunal, the CCMA, or the National Consumer Commission).No Guarantees: Complaints Authority SA provides administrative assistance only; it gives no guarantee, warranty, or assurance of a successful outcome. Liability Waiver: Complaints Authority SA, its directors, and its agents hold no liability for adverse rulings, dismissed claims, delays by statutory bodies, or any subsequent financial losses.3. Institutional Forum Restrictions & Self-Representation Agreement. I am aware that certain statutory forums, tribunals, and Ombuds do not legally permit third-party paid consultants to formally file or appear on behalf of a complainant. I explicitly acknowledge that where these institutional restrictions apply: Assisted Self-Representation: The service provided by Complaints Authority SA is strictly limited to behind-the-scenes support, including professional document preparation, case file structuring, evidence collation, and procedural coaching. Submission Mandate: I remain the primary complainant and am solely responsible for formally signing, submitting, and presenting the prepared case directly in my own name. No Violation of Rules: I understand that Complaints Authority SA will not attempt to bypass forum rules or misrepresent its role in proceedings that forbid consultant intervention.5. Protection of Personal Information Act (POPIA) Data Consent. I hereby grant explicit consent to Complaints Authority SA (PTY) LTD to collect, store, and process my personal data, identity documents, and dispute-related evidence. I understand that: This information will be used solely for evaluating, structuring, and preparing my file. My data will only be shared with relevant internal personnel and necessary regulatory bodies within South Africa. I retain the right to access, update, or withdraw my consent at any time by contacting the designated Information Officer.
Do you authorize a representative to act as your proxy?
Proxy Authorization Mandate (Registration No. 2026/410971/07)
ID Upload

ID & Passport Submission Notice (POPIA Compliance) Please upload a clear copy of your South African ID document or passport. Purpose: This file is collected strictly to verify your identity and validate your signed Proxy Authorization Mandate. Security: Your document is transmitted through secure, encrypted channels and will only be accessible to authorized compliance personnel. Retention: In accordance with POPIA rules, this document will not be kept longer than necessary and will be permanently deleted once your dispute file assessment is closed or completed.
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Complaints Management Services
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First 30 Minute Online Consultation & Case Assessment (Discounted)
99.00 ZAR

Total

0.00 ZAR
Digital Signature

By signing above, I explicitly confirm that I have read, understood, and accept the Statutory Compliance & Legal Disclaimers, Private Consultancy Disclosures, Fee Policies, and POPIA Consent outlined in this document. I intend this digital signature to be my legally binding acknowledgment and authorization of the Proxy Authorization Mandate.
Date

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⚠️ Payment Required Before Submission:

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Your complaint details and proxy mandate will not be submitted to us until your bank payment is successful.
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Complaints Form – Client Mandate & Terms of Business

Statutory Compliance & Legal Disclaimers

Complaints Management Services*

Complaints Management Services