Complaint

Keluhan Pelanggan

Personal Data

Reporting Name

Insured Name

Policy No

Active Phone of the Insured / Informer

Active Email of the Insured / Informer

Branch Office where the Policy is create

Form of Complaint & Types of products

Lisan

Tertulis

Cause

Klaim Belum Dibayarkan

Nilai Klaim Tidak Sesuai

Penolakan Klaim dari Jastan

Lainnya

Summary of Complaints

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