Complaint Form
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Email Address
Subject
Please describe the incident
Service requested
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File a Claim
Report a Complaint
Category
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Sub-category
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FOR CLAIMS ONLY: Please provide detailed address of the claim
First Name
Middle name
Last Name
Company name (in case the policyholder is a company)
Phone Number
Relationship with Bankers
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Customer
Broker
Agent
Third party
Service provider
Employee
Other
Contact at Bankers
Policy Number, if any
Claim Number, if any
Type of Coverage
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Motor Insurance
Medical Insurance
Life Insurance
Marine Insurance
Property & Casualty Insurance
PA Insurance
FOR COMPLAINTS ONLY: Please describe what would you consider to be a fair resolution to your complaint.
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