Formal Complaints form - Infiniti Insurance

Formal Complaint Form

Infiniti Compliance Officer
complaints@infinitiafrica.com
P O Box 23
Strathavon
2031

Name(s) and Surname

Telephone number

ID Number

Broker Name

Client Policy Number

Email Address

Nature of Complaint

Infiniti Insurance Limited or its representative has contravened or failed to comply with any provision of the Financial Advisory & Intermediary service Act, 2002 and that as a result thereof, the complainant has suffered or is likely to suffer financial prejudice or damage. Infiniti Insurance Limited or its representative has willfully or negligently rendered a financial service to the complainant which has caused prejudice or damage to the complainant which is likely to result in such prejudice or damage. Infiniti Insurance Limited or its representative has treated the complainant unfairly.

Details of Complaint

Please attach copies of all relevant documentation in support of the complaint

Number of pages attached

I have read and understood the Infiniti Insurance Complaints Procedure in my policy documentation.

By submitting this form you acknowledge the terms and conditions of the above process.

An Insurer licensed to conduct Non-Life insurance business and an Authorised Financial Services Provider | FSP No. 35914