Customer Complaint Form

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Hits - Bandwidth BEGIN_DOWNLOADS 0 END_DOWNLOADS # OS ID - Hits BEGIN_OS ID - Hits - Pages 0 END_OS # Browser ID - Hits - Pages BEGIN_BROWSER 0 END_BROWSER # Screen size - Hits BEGIN_SCREENSIZE 0 END_SCREENSIZE # Unknown referer OS - Last visit date BEGIN_UNKNOWNREFERER 0 END_UNKNOWNREFERER # Unknown referer Browser - Last visit date BEGIN_UNKNOWNREFERERBROWSER 0 END_UNKNOWNREFERERBROWSER # Origin - Pages - Hits BEGIN_ORIGIN 6 From0 0 0 From1 0 0 From2 0 0 From3 0 0 From4 0 0 From5 0 0 END_ORIGIN # Search engine referers ID - Pages - Hits BEGIN_SEREFERRALS 0 END_SEREFERRALS # External page referers - Pages - Hits # The 25 first Pages must be first (order not required for others) BEGIN_PAGEREFS 0 END_PAGEREFS # Search keyphrases - Number of search # The 10 first number of search must be first (order not required for others) BEGIN_SEARCHWORDS 0 END_SEARCHWORDS # Search keywords - Number of search # The 25 first number of search must be first (order not required for others) BEGIN_KEYWORDS 0 END_KEYWORDS # Errors - Hits - Bandwidth BEGIN_ERRORS 1 301 1555298 356163242 END_ERRORS # URL with 404 errors - Hits - Last URL referrer BEGIN_SIDER_404 0 END_SIDER_404 # Host - Pages - Hits - Bandwidth - Last visit date - [Start date of last visit] - [Last page of last visit] # [Start date of last visit] and [Last page of last visit] are saved only if session is not finished # The 25 first Hits must be first (order not required for others) BEGIN_VISITOR 0 END_VISITOR # Date - Pages - Hits - Bandwidth - Visits BEGIN_DAY 0 END_DAY # Session range - Number of visits BEGIN_SESSION 0 END_SESSION # URL - Pages - Bandwidth - Entry - Exit # The 25 first Pages must be first (order not required for others) BEGIN_SIDER 0 END_SIDER # Payload Range - Payload Frequency BEGIN_FILESIZE 1 100-500 1555298 END_FILESIZE

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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.

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Authorised and regulated by Otoritas Jasa Keuangan (OJK).
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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