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Complaints Form

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The Insurance Regulatory Authority has a mandate to protect the interests of policy holders. The Authority therefore takes complaints seriously and has developed an internal procedure for handling complaints. Please use this form to tell us about your complaint so we can be able to help you. If you’re not sure about anything or have any difficulties filling in this form, you can get in touch with us by phone or email. Contact Us.

1. Please give us information about yourself.

Surname *
Other Name(s)
Occupation *
Date of Birth
Telephone
Mobile Phone *
Email Address

2. Details of the registered member you are complaining against.

Name *
Address (include postal code)
Their Phone Number

3. If the complaint is against an insurance company, then provide the following details.

Type of policy *
Policy Number *
Claim Number *

4. Time limits may apply to your complaint- so we need to know the following dates.

When did it take place? When did the dissatisfaction you are complaining about take place?
When did you first complain to the registered member about it? When did you first complain to the registered member about it?

5. A few more questions

When did you get the final word on the complaint?
Has there been any court action relating to your complaint(or any planned)?
YES
NO

6. Particulars of the complaint.

Type details of your complaint here. *

7. Make sure you have .......

(i) given us any details that you think will help us understand your complaint.

(ii) enclose copies of relevant documents.

8. By submitting this application form, you will have declared:

I would like the Insurance Regulatory Authority to consider my complaint. I confirm that all the information I have given you is true and accurate to the best of my knowledge.

I understand that:

(i) you will need to handle personal details about me which could include sensitive information inorder to deal with my complaint effectively;

(ii) you may need to exchange information about my compliant with the insurance company I have complained about and any other relevant organisations;

(iii) you may publish examples of where things can go wrong, based on real cases, but you will always respect my privacy and keep my personal informationn confidential.

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