Title - None -MrMsMrsOther First name * Surname * Address Email address * Contact number * What is the name of the company or individual you are complaining about? * What happened? Please tell us the details of your complaint. * How would you like this complaint to be resolved? * Who have you spoken to about your complaint? What was their response and when did you receive it? Is a representative helping you? - None -YesNo Can we send the information about your complaint to the company or individual your complaint is about? - None -YesNo Can the company or the individual your complaint is about contact you? - None -YesNo How did you hear about us? - None -From the person/business your complaint is aboutInternet searchFinancial mentor/budgeterWord of mouthAnother Dispute Resolution SchemeMedia articleOther Can we ask you some demographic questions? - None -YesNo Where in New Zealand are you based? How would you describe your circumstances? - None -Employed (salary or wages)Self-employedRetiredStudentLooking for workNot looking for workPrefer not to say How would you describe your ethnicity? - None -Asian(including Indian)MāoriNZ European/PākehāPacific peopleOtherPrefer not to say How old you? - None -Under 2020-2930-3940-4950-5960-69Over 70Prefer not to say Submit
