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COMPANY L/H COMPANY P/CCOMPLAINT QUESTIONNAIRE NORTH DAKOTA STATE INSURANCE DEPARTMENTIssue No.:SFN 18956 (122006)Sent By:Date Name of Insured AddressHome Telephone NumberWork Telephone NumberCityStateZip

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How to fill out complaint questionnaire

01

To fill out a complaint questionnaire, follow these steps:

02

Start by carefully reading the instructions provided with the questionnaire.

03

Begin by filling out your personal information, such as your name, address, contact details, etc.

04

Next, describe the nature of your complaint and provide specific details about the incident or situation.

05

If applicable, include any supporting evidence or documentation that may help in the investigation of your complaint.

06

Answer any additional questions or sections included in the questionnaire, ensuring you provide accurate and relevant information.

07

Review your completed questionnaire to ensure all fields are filled correctly and no important information is missing.

08

Sign and date the questionnaire, as required.

09

Make a copy of the completed questionnaire for your own records.

10

Submit the filled out questionnaire to the designated authority or department as instructed. Follow any additional submission requirements if specified.

11

If necessary, keep a record or proof of submission for future reference or follow-up.

Who needs complaint questionnaire?

01

A complaint questionnaire may be needed by individuals or entities who have experienced or witnessed an incident, action, or behavior that they believe needs to be reported or addressed.

02

Examples of who may need a complaint questionnaire include:

03

- Customers who wish to file a complaint against a product or service

04

- Employees who want to report any form of misconduct or harassment in the workplace

05

- Students or parents who need to document and raise concerns about educational institutions

06

- Patients who have experienced issues with healthcare providers or facilities

07

- Members of the public who have witnessed potential criminal activities or violations

08

- Any individual or organization that wants to formally report an issue or problem for resolution and investigation.

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What is complaint questionnaire?

A complaint questionnaire is a document used by individuals or entities to formally report grievances or issues regarding products, services, or practices.

Who is required to file complaint questionnaire?

Individuals, organizations, or entities that have experienced a violation or issue related to products or services that warrant formal reporting are required to file a complaint questionnaire.

How to fill out complaint questionnaire?

To fill out a complaint questionnaire, provide detailed information about the complaint, including personal information, the nature of the complaint, relevant dates, and any supporting evidence or documentation.

What is the purpose of complaint questionnaire?

The purpose of a complaint questionnaire is to gather information systematically to facilitate the investigation and resolution of reported issues or grievances.

What information must be reported on complaint questionnaire?

The questionnaire typically requires personal details, a description of the complaint, the parties involved, relevant dates, and any attached documentation to support the claim.

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