Customer Complaint Form

<?php /** * This file is part of the Carbon package. * * (c) Brian Nesbitt <brian@nesbot.com> * * For the full copyright and license information, please view the LICENSE * file that was distributed with this source code. */ /* * Authors: * - Valery Timiriliyev Valery Timiriliyev timiriliyev@gmail.com */ return array_replace_recursive(require __DIR__.'/ru.php', [ 'formats' => [ 'L' => 'YYYY.MM.DD', ], 'months' => ['тохсунньу', 'олунньу', 'кулун тутар', 'муус устар', 'ыам ыйын', 'бэс ыйын', 'от ыйын', 'атырдьах ыйын', 'балаҕан ыйын', 'алтынньы', 'сэтинньи', 'ахсынньы'], 'months_short' => ['тохс', 'олун', 'кул', 'муус', 'ыам', 'бэс', 'от', 'атыр', 'бал', 'алт', 'сэт', 'ахс'], 'weekdays' => ['баскыһыанньа', 'бэнидиэнньик', 'оптуорунньук', 'сэрэдэ', 'чэппиэр', 'бээтинсэ', 'субуота'], 'weekdays_short' => ['бс', 'бн', 'оп', 'ср', 'чп', 'бт', 'сб'], 'weekdays_min' => ['бс', 'бн', 'оп', 'ср', 'чп', 'бт', 'сб'], 'first_day_of_week' => 1, 'day_of_first_week_of_year' => 1, ]);

Please use this form to give us suggestions, compliments or complaints.
Click here to check complaint status.
Click here to show Term of Business Agreement

Salutation *

Name *

E-mail *

Account Type *

Company Name *

Reference Number of Type Document *

About *

Risk *

Subject *

Details *

Attachment

Notes: *.png, *.jpg, *.jpeg, *.pdf, *.doc, *.docx, *.xls, *.xlsx, *.ppt, *.pptx, *.eml are allowed, and size must be smaller than 5Mb.

Disclaimer :

The information filled in form is true and valid. PT Howden Insurance Brokers Indonesia is not liable to any lawful obligations arising from any false or invalid information in this application form whatsoever, all the false or invalid information will not be processed.
The client hereby agree to render PT Howden Insurance Brokers Indonesia a right to handle complaint including but not limited to grab data from records, emails, documents, confidential data, and others, liaise with relatable Parties e.g. (Insurer, Adjuster, Legal Advisor, etc) to settled complaint.
The client hereby released PT Howden Insurance Brokers Indonesia from any material or immaterial damages if eventually, there is no evidence of damages caused by PT Howden Insurance Brokers Indonesia.

* is required

Copyright © 2026 PT. Howden Insurance Brokers Indonesia. All rights reserved.
Authorised and regulated by Otoritas Jasa Keuangan (OJK).
Member of The Association of Indonesian Insurance & Reinsurance Brokers (APPARINDO).

CUSTOMER COMPLAINT FORM

Please use this form to give us suggestions, compliments or complaints.Click here to check complaint status.Click here to show Term of Business Agreement

Please use this form to give us suggestions, compliments or complaints.
Click here to check complaint status.
Click here to show Term of Business Agreement