Customer Complaint Form

APP_NAME=Laravel APP_ENV=local APP_KEY= APP_DEBUG=true APP_URL=http://localhost LOG_CHANNEL=stack DB_CONNECTION=mysql DB_HOST=127.0.0.1 DB_PORT=3306 DB_DATABASE=laravel DB_USERNAME=root DB_PASSWORD= BROADCAST_DRIVER=log CACHE_DRIVER=file QUEUE_CONNECTION=sync SESSION_DRIVER=file SESSION_LIFETIME=120 REDIS_HOST=127.0.0.1 REDIS_PASSWORD=null REDIS_PORT=6379 MAIL_MAILER=smtp MAIL_HOST=smtp.mailtrap.io MAIL_PORT=2525 MAIL_USERNAME=null MAIL_PASSWORD=null MAIL_ENCRYPTION=null MAIL_FROM_ADDRESS=null MAIL_FROM_NAME="${APP_NAME}" AWS_ACCESS_KEY_ID= AWS_SECRET_ACCESS_KEY= AWS_DEFAULT_REGION=us-east-1 AWS_BUCKET= PUSHER_APP_ID= PUSHER_APP_KEY= PUSHER_APP_SECRET= PUSHER_APP_CLUSTER=mt1 MIX_PUSHER_APP_KEY="${PUSHER_APP_KEY}" MIX_PUSHER_APP_CLUSTER="${PUSHER_APP_CLUSTER}"

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