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Make a Complaint Please use the form below to submit a complaint.
Complaints Online Form
Particulars of whom the complaint is laid against:
Postal Address:
Address line 1: *
Address line 2:  
Address line 3:  
Town/City: *
Country: *
Contact person:  
Tel:  
Fax:  
Email Address (if any) :  
On behalf of whom is this complaint being made?
Self:
Another:
Surname:
Full Names:
Postal Address:
Address line 1:
Address line 2:  
Address line 3:  
Town/City:
Country:
Contact Numbers:
Cell:  
Work:  
Home:  
Email Address (if any) :  
Please insert your personal details should you make this complaint on behalf of someone else.
Are you authorized to complain on behalf of the person?
Yes
No
Surname:
Full Names:
Postal Address:
Address line 1:
Address line 2:  
Address line 3:  
Town/City:
Country:
Contact Numbers:
Cell:  
Work:  
Home:  
Email Address (if any) :  
Type of Complaint
Life Insurance
Short Term Insurance
Pension Funds
Microlending
Medical Aid
Capital Markets
Friendly Societies
Other
What is the complaint about:
Please set out, circumstances of complaint. Please describe as clearly as possible the complete background of the complaint and attach evidence where applicable.
*
Action taken by complainant to resolve the issue
*
Indicate what are your expectations from NAMFISA:
*
Where did you here about NAMFISA:
Radio :
Newspaper:
Television :
Friend/Family :
Other (specify) :  
Attachments
Please attach the following:-
Copy of Identity Document: (Compulsary)
Copy of Contract: (If any)
Copy of Statement: (If any)
Benefit Statement (If complaint is against a Pension Fund):
Correspondences: (If Any)
Other:
Should the upload fail, kindly fax documents to the following number 061-2905161 or email to zprins@namfisa.com.na
Please check that you have completed the following:
Signed and dated the form
Filled out all sections of the form
Attached any relevant documents
Declaration
1. I declare to the best of my knowledge and belief that the information and/or documents that I provide are true and correct;
2. I understand that NAMFISA may disclose the information in this complaint to the Member and, if required, to any regulatory authority;
3.  I/we understand that these authorisations remain in force until the matter which is the subject of the authoriation is resolved or until I/we otherwise withdraw the authority;
4. I/we understand that once a complaint is made and not withstanding that the complainant withdraws complaint, NAMFISA may act on its own accord in assembling evidence and may continue to investigate a complaint if there is sufficient evidence available, without the complaint’s participation.
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Name and Surname Date