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Print Form INSURANCE DIVISION HEALTH BRANCH PO BOX 3614 HONOLULUHAWAIIAI I 96811-3614 PHONE NO: (808) 586-2804 FAX NO: (808) 587-5379 www.hawaii.gov/dcca/areas/ins COMPLAINT/INQUIRY FORM YOUR INFORMATION
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How to fill out a complaint/inquiry form:

01
Start by carefully reading the instructions provided on the form. This will give you a clear understanding of what information is required and how to fill out the form properly.
02
Begin by providing your personal details, such as your full name, contact information, and any identification numbers that may be necessary.
03
Next, specify the nature of your complaint or inquiry. Clearly and concisely describe the issue or problem you are facing, providing as much detail and supporting evidence as possible.
04
If there are specific dates, times, or locations relevant to your complaint or inquiry, make sure to include them in the appropriate sections of the form.
05
Consider attaching any relevant documents, such as receipts, invoices, or correspondence related to your complaint or inquiry. This can help provide additional evidence and support your case.
06
Double-check all the information you have provided on the form for accuracy and completeness. Make sure your contact details are correct and that you have answered all the required questions.
07
If there are any specific instructions provided on the form regarding submission, follow them carefully. This may involve mailing the form, submitting it in person, or submitting it online.
08
Finally, submit the completed form within the designated timeframe to ensure that your complaint or inquiry is processed in a timely manner.

Who needs a complaint/inquiry form?

01
Anyone who has an issue or concern that needs to be addressed by an organization or authority may need to fill out a complaint/inquiry form.
02
Customers who have received substandard goods or services may use a complaint form to seek resolution or compensation.
03
Employees who have encountered workplace issues or violations may need to fill out an inquiry form to initiate an investigation.
04
Students who have academic concerns or complaints, such as grading discrepancies or unfair treatment, may be required to submit a complaint or inquiry form to their educational institution.
05
Individuals who have encountered legal or administrative problems may need to fill out a complaint form to seek legal recourse or assistance.
In summary, anyone who wants to formally register their complaint, concern, or inquiry with an organization, authority, or institution will likely need to fill out a complaint/inquiry form.
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The complaintinquiry form is a document used to report complaints or inquiries to the relevant authority.
Anyone who has a complaint or inquiry related to the specified topic is required to file a complaintinquiry form.
The complaintinquiry form can be filled out by providing detailed information about the complaint or inquiry in the designated fields.
The purpose of the complaintinquiry form is to officially document and address complaints or inquiries in a systematic manner.
The complaintinquiry form must include details such as name, contact information, description of the complaint or inquiry, and any supporting documents.
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