Home » Complaint Submission Form

Complaint Submission Form

If you prefer to download the complaint submission form, please click the download link below:

Download ‘Complaint Submission Form’

Please send the completed form along with any supporting documentation to the Complaints Department using the following email address: complaints@cifsa.org

Electronic Complaint Submission Form

If you prefer to use the electronic version of the form, please fill in the form below, all fields marked with an asterisk (*) are required:

    Part 1 - Your personal details

    Name:*

    Postal Address:*

    Email Address:*

    Telephone Number:*

    Does your complaint relate to your own policy?

    Please note CIFSA are only able to consider complaints lodged by the policy owner.

     

    Part 2 - Details of the Advisor/Firm complaint is made against

    Name of Individual(s):*Separate names with a comma (,)

    Name of Firm:*

    Firm Address:*

    Adviser’s Regulator:*

    Firm Regulatory Approval Number:*

    Has another IFA firm ever been appointed to service your policy?

    Please note we will require a full history of your nominated Financial Advisers and dates (please provide with this form).

    Was this firm your appointed agent at the time of the alleged failing?

    Please note that CIFSA require details of the firm/individual whom provided the advice at the time of the alleged failing.

    Is the Firm a CIFSA member?

     

    Part 3 - Details of your complaint

    Please detail your complaint, including dates, alleged failings, and full details of your complaint, along with your proposed resolution and desired outcome. Please remember to include all details as CIFSA is unable to accept further submissions or details after your initial submission.*

    Have you complained to the IFA Firm?

    Does your complaint relate to Investment Performance?

    If YES – did you choose/instruct your own Investments?

    Why were you not satisfied with their response?*

    Are you providing additional evidence at this stage that your Initial Complaint did not Include? (if appropriate)

    Have you included a full copy of the complaint and response herein?

    When do you allege that the failure occurred?*

    When did you notice the alleged failure?*

    Have you complained to any other body/entity concerning this failure?

    If YES please provide details:

     

    Part 4 - Supporting Documentation

    Please detail and upload any supporting documents you wish to include with your complaint submission:

    Document 1: (enter details below)


    Accepted file types: .PDF | .DOC | .DOCX

    Document 2: (enter details below)


    Accepted file types: .PDF | .DOC | .DOCX

    Document 3: (enter details below)


    Accepted file types: .PDF | .DOC | .DOCX

    Document 4: (enter details below)


    Accepted file types: .PDF | .DOC | .DOCX

    Document 5: (enter details below)


    Accepted file types: .PDF | .DOC | .DOCX

    Document 6: (enter details below)


    Accepted file types: .PDF | .DOC | .DOCX

    Document 7: (enter details below)


    Accepted file types: .PDF | .DOC | .DOCX

    Document 8: (enter details below)


    Accepted file types: .PDF | .DOC | .DOCX

     

    Part 5 - Your Declarations (please tick to acknowledge)

    a.) You understand CIFSA’s services are limited to endeavor to mediate a mutually acceptable resolution:*

     

    b.) CIFSA is only able to investigate complaints against member firms:*

     

    c.) You understand CIFSA is not always able to reach a conclusion:*

     

    d.) You understand any ruling or decision made by CIFSA is not binding on the parties involved and CIFSA has no authority, legal or otherwise, to enforce any suggested action, remedy, or resolution:*

     

    e.) You understand CIFSA is unable to intervene where the complainant has already pursued other avenues of complaint, e.g. legal action:*

     

    f.) You understand you have the right to complain directly to the relevant regulator, or pursue legal action:*

     

    g.) You confirm you have read and understood the CIFSA complaints procedure:*

     

     

    Part 6 - Authority Provision (please tick to acknowledge)

    a.) You provide authority to CIFSA to request documentation from relevant parties including your personal data in order to investigate your complaint (please complete attached form):*

     

    b.) You provide authority for CIFSA to share information with the relevant regulator(s):*

     

    c.) You provide authority for CIFSA to contact providers and other parties involved to request information data in order to investigate your complaint:*

     

    d.) You confirm that the information herein is true, accurate, and complete to the best of your knowledge and belief, and that we are unable to consider information other than that provided herein:*

     

    Please note that no further information shall be accepted and as such it is important you declare all grievances herein and provide all evidence available to you.

     

    Name of Policyholder 1:*

    Name of Policyholder 2:*

    Date:*

     

     

    Part 7 - Authority Form

    AUTHORITY TO PROVIDE INFORMATION TO CIFSA ENABLING THE COMPLAINTS DEPARTMENT TO OBTAIN INFORMATION IN ORDER TO INVESTIGATE COMPLAINT

     

    Please note: In order for CIFSA to obtain information pertaining to your complaint, please click here to download, fill in, sign, scan and attach the 'Authority Provision' form below:*

     


    Accepted file types: .PDF | .DOC | .DOCX

     

     

    Before submitting, please ensure that you have entered ALL the required fields marked with an asterisk (*).

     

    Comments are closed.