CPI Complaint - Monarch Insurance

Insurance Complaint Form

Customer Protection Insurance - South Africa:

Please comlete the below section in full in order to avoid unnecessary delays in the review of your comlaint.

A. To submit a complaint or follow-up on a complaint or to provide us with aditional required documentation, you can contact us in any of the folowing ways:

Hand in at your learest branch.
Email directly to: insurancecomplaints@lewisgroup.co.za ; OR
Contact the insurance call center on 0800 000 598 to discuss your complaint.

B. POLICYHOLDER / COMPLAINANT INFORMATION:

Date*

Store Name*

Branch Number*

Account Number*

Customer Name*

Customer ID Number*

Contact Cellphone Number*

Alternative Contact Number*

Email Address*

C. COMPLAINT PARTICULARS:

Please select which insurance product your complaint relates to:

What does your complaint relate to:

D. FULL REASONS AND DETAILS OF THE COMPLAINT: (PLEASE INCLUDE ALL RELEVANT DATES)

Content

E. DETAILS OF ANY OTHER DOCUMENTS ATTACHED: (PLEASE LIST ANY OTHER DOCUMENTS ATTACHED REGARDING THE COMPLAINT.)

Content

F. DECLARATION

I, with the above-mentioned particulars and the undersigned, do hereby declare that the information contained in this complaint form is true and correct to the best of my knowledge and belief. I expressly consent to Monarch Insurance Company Limited (‘MICL’) requesting and receiving personal information related to me/the insured, which personal information is, in the opinion of MICL, necessary to assess my insurance complaint and/or claim. I hereby irrevocably indemnify any person which provides MICL with my/the insured’s personal information in terms of my aforesaid consent.

Name Of Claimant / Policyholder

Name Of Branch Manager

Date

By entering your name and date above, you are providing an electronic signature, indicating your agreement with the contents of this form.

Oct2023_CPI_RSA

PLEASE NOTE: (Information for the Policyholder / Complainant)

To ensure we provide you, the policyholder / complainant with timely and adequate feedback please complete your contact details.
If the complaint is lodged with a Lewis branch the form must be completed in duplicate and signed by yourself (the policyholder / complainant) and the Branch Manager.
You (the policyholder / complainant) must retain a copy of this form as proof of submitting a complaint.
Please refer to section A - ‘Submit a Complaint / Follow-up on a Complaint’ at the beginning of the form on how to submit a complaint and/or follow-up on your complaint.

WHAT TO EXPECT:

The insurance complaints department will deal with the complaint as quickly as possible and undertakes to provide you, the policyholder / complainant with the following information in a timely manner:
1. Your complaint reference number,
2. The complaints officer dealing with your complaint, and
3. The escalation process if you are not satisfied with the progress of your complaint.
We undertake to address your complaint and provide you with the outcome within 14 working days.
Should you need to contact the Insurance Call Center, call 0800 243 675 and ask for the Complaints Officer. (Please ensure that your policy number or your I.D. number are on all correspondence submitted regarding the complaint)
If the matter is not resolved to your satisfaction, you may lodge your complaint with either of the following ombuds’ offices:

The National Financial Ombud Scheme:

Telephone number: 0860-800-900
Email address: info@nfosa.co.za
Website address: www.nfosa.co.za

NFO Cape Town Office
Claremont Central Building
6th Floor
6 Vineyard Road, Claremont
Western Province
7700

NFO Johannesburg Office
110 Oxford Rd
Houghton Estate
Johannesburg
Gauteng
2198

The FAIS Ombudsman:

Telephone: (012) 470-9080
Share-call: 0860 663 247
Email: info@faisombud.co.za
Website: www.faisombud.co.za
The FAIS Ombud deals with complaints submitted to the Office by a specific client against the FSP. Refer to the website as noted above for more details.

AnnexureA-102023_CPI_InsuranceComplaintform_RSA