# The MIT License (MIT)

Copyright (c) 2016 PHP Framework Interoperability Group

> Permission is hereby granted, free of charge, to any person obtaining a copy
> of this software and associated documentation files (the "Software"), to deal
> in the Software without restriction, including without limitation the rights
> to use, copy, modify, merge, publish, distribute, sublicense, and/or sell
> copies of the Software, and to permit persons to whom the Software is
> furnished to do so, subject to the following conditions:
>
> The above copyright notice and this permission notice shall be included in
> all copies or substantial portions of the Software.
>
> THE SOFTWARE IS PROVIDED "AS IS", WITHOUT WARRANTY OF ANY KIND, EXPRESS OR
> IMPLIED, INCLUDING BUT NOT LIMITED TO THE WARRANTIES OF MERCHANTABILITY,
> FITNESS FOR A PARTICULAR PURPOSE AND NONINFRINGEMENT. IN NO EVENT SHALL THE
> AUTHORS OR COPYRIGHT HOLDERS BE LIABLE FOR ANY CLAIM, DAMAGES OR OTHER
> LIABILITY, WHETHER IN AN ACTION OF CONTRACT, TORT OR OTHERWISE, ARISING FROM,
> OUT OF OR IN CONNECTION WITH THE SOFTWARE OR THE USE OR OTHER DEALINGS IN
> THE SOFTWARE.

• [D] src
• [F] .editorconfig
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• [F] composer.json
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• [F] LICENSE.md
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• [F] README.md
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CUSTOMER COMPLAINT FORM

Please use this form to give us suggestions, compliments or complaints.
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Salutation *

-- Please Choose -- Mr. Mrs. Ms. PT. CV. UD.

Name *

E-mail *

Account Type *

-- Please Choose -- Individual Company

Company Name *

Reference Number of Type Document *

-- Please Choose -- Policy Contract Invoice Number

*

About *

-- Please Choose -- Claim Service System

Risk *

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Subject *

Details *

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• 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.

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Authorised and regulated by Otoritas Jasa Keuangan (OJK).
Member of The Association of Indonesian Insurance & Reinsurance Brokers (APPARINDO).