CONSUMER COMPLAINT FORM

(In accordance with the Consumer Protection and Safety Act No. 30 of 1985)

Please note we can only assist with complaints where the goods and services are advertised and purchased in Trinidad and Tobago - for those outside Trinidad and Tobago please refer to your local Consumer Agency.

CONSUMER INFORMATION * Required Fields
First Name	*	Last Name	*
Middle Initial		Occupation	*
Address (Street)	*	Age	*
Address (cont.)		Gender	*
City/Town	*	E-mail
Phone	*	FAX
Work Phone

SUPPLIER INFORMATION
Business name		Business contact
Address		Fax
City/town		E-mail
Phone		If Yes, describe
Have you contacted the supplier		If Yes, describe

PRODUCT / SERVICE INFORMATION
Product/service involved		Brand
Country of origin		Model No.
Date of purchase		Serial No.
Guarantee/ warranty		Length (months)

Technical Information
Date of manufacture		Standards mark
Electrical frequency rating		Required voltage
Describe the facts of your complaint		What is considered a satisfactory solution
By submitting this complaint form, I certify that the foregoing statements made by me are true and correct to the best of my knowledge and belief. I am willing to testify to any proceedings related to this complaint if required.

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CONSUMER COMPLAINT FORM

CONSUMER INFORMATION

SUPPLIER INFORMATION

PRODUCT / SERVICE INFORMATION

Technical Information