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Request for mediation
Send complaint form
Complaint form
Caution: fields with a * are required
Postal or parcel company involved
*
Has the problem already been notified to the company ?
Yes
No
*
By what means ?
Electronically
Date:
Contact person:
Address:
By letter
Date:
Contact person:
Address:
By fax
Date:
Contact person:
Fax number:
In person
Date:
Contact person:
Place or telephone number:
Caution: if you have notified your problem in another way or if you have several complaints, please mention this in the box: Your problem.
Did you receive an answer ?
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*
Caution: please send us a copy of the answer. You can send or fax it to us or attach it to the form or your e-mail. Should the reference number used by the complaint's department of the company involved be available, please send us this as Well.
Your problem
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Your contact details
Sir
Madam
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Name:
*
First name:
*
In case you represent a company or organisation
Name of the company, organisation,...:
Your position:
Address:
*
Number:
*
PO box:
Postal code:
*
Place:
*
Country:
*
Telephone:
Fax:
E-mail:
*
Confirmation e-mail
E-mail:
*
In case of a compensation payment:
IBAN account number:
BIC account number:
Did you verify all data ?
Caution:
You will receive a copy of your complaint at the address indicated after you press “SEND”.
As soon as your request for mediation is registered, a confirmation of receipt will be sent to you including a reference number, the name and the contact details of the person treating your case.
Koning Albert II-laan 8 box 4, 1000 Brussel - Tel: 02 221 02 20 - Fax: 02 221 02 44 - E-mail:
info@omps.be
van Dijk I.C.