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Case
Title
*
First Name
*
Surname
*
Policy Number (Enter NA if unknown)
*
Mobile Phone
E-mail Address
Description Of Complaint Issue
*
HIDETAB
Yes
No
Budget Direct
ING
Qantas Insurance
Virgin Money
Macquarie
Australia Post Insurance
Dodo Insurance
Latitude Insurance
Maxxia
1st for Women
Aussie
1COVER INSURANCE
1300 Insurance
YourShare
Cashback
Retirease
OVER60 INSURANCE
Best Buy
ibuyeco
Ozicare
HIA Insurance Services
Affinity
Catch
Aussie Insurance
OCEANIA INSURANCE
Auto & General
Policy Holder
Parent / Legal Guardian
Family Member
Power of Attorney
Executor of an Estate
Legal Representative
Broker
Friend/Colleague
AFCA Case Officer
Third Party Complainant
Third Party Partner Representative
Email
Letter
Home Phone
Mobile Phone
Work Phone
Individual
Small Business
Not Stated/Unknown
Yes
No
Phone Call
Exec Office
Email
Chat
Social Media
Referral from AFCA
Letter
VOCAL
Website / Online Form
Face to Face
Other
Submit