Intake form

Help us serve you better

Name *

Email address *

What type of grievance are you submitting?

Please select at least one option.

Service Quality

Product Issue

Billing Problem

Feedback

Please specify the category of your grievance.

What is the date of the incident?

Please provide any related reference number (if applicable).

How would you prefer to be contacted regarding your grievance?

Please select at least one option.

Phone

SMS

Please provide your phone number for contact.

What is your preferred method of resolution?

Please provide any additional details or comments.

Additional questions or comments

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