Full Name
E-mail Address
Phone Number (optional)
Preferred Contact Method E-mailPhone
Name of the Company/Business You Are Complaining About
Type of Company:
Utility ProviderRetailerFinancial InstitutionOther (please specify):
What is the nature of your complaint? Poor ServiceFaulty GoodsUnfair ChargesBreach of ContractOther (please specify):
Briefly describe your issue (max 500 words):
What resolution are you seeking?
Have you contacted the company? YesNo
If Yes:
How did you contact them? EmailPhoneLetterIn-person
Have you received a response? YesNoIf Yes, what did they say? (Attach correspondence if available.)
Upload any relevant documents (e.g., receipts, contracts, emails, photos). (Attach files: PDF, DOC, JPEG, PNG – max size: 10MB)
I confirm that the information provided is accurate to the best of my knowledgeI agree to Golden Shield Consumer Services’ terms and conditions and privacy policy.
