Make a complaint about a financial service provider who is a FSCL participant. "*" indicates required fields Title-Select-MrMrsMsSirMadamOtherOther title First names* Surname* Email address* Phone* Address What is the name of the company or individual you are complaining about?* What happened?*Please tell us the details of your complaint.How would you like this complaint to be resolved?*Who have you spoken to about your complaint?What was their response and when did you receive it?If a representative is helping you with this complaint, could you please give us their name and contact details?Can we send the information about your complaint to the company or individual your complaint is about?-Select-NoYesCan the company or the individual your complaint is about contact you?-Select-NoYesHow did you hear about us?NoneFrom the person/business your complaint is aboutInternet searchFinancial mentor/budgeterWord of mouthAnother Dispute Resolution SchemeMedia articleOtherCan we ask you some demographic questions?-Select-NoYesWhere in New Zealand are you based?-Select-NorthlandAucklandWaikatoBay of PlentyTaranakiWhanganui/ManawatuEast CoastHawkes BayWellingtonNelson/TasmanMarlboroughWest CoastCanterburyOtagoSouthlandChatham IslandsInternationalPrefer not to sayHow would you describe your circumstances?-Select-Employed (salary or wages)Self-employedRetiredStudentLooking for workNot looking for workPrefer not to sayHow would you describe your ethnicity?- Select -Asian(including Indian)MāoriNZ European/PākehāPacific peopleOtherPrefer not to sayHow old you?- Select -Under 2020-2930-3940-4950-5960-69Over 70Prefer not to say
