Please complete this form to lodge your complaint to the CBE. Should you need assistance to complete the form, kindly contact the Legal Department on (012) 346 3985 or email meltonia@cbe.org.za

All fields marked with * are compulsory.

Complainant Details

Surname*

First Name(s)*

Identity/Passport Number*

Residential Address*

Postal Address

Contact Details

Telephone No.*

Alternative Contact No.

Email Address*

Occupation*

Are you complaining in your personal capacity or acting on behalf of another person or organisation?
—Please choose an option—Personal capacityOther person/organisation

If acting on behalf of another person or organisation, please provide details

Name of person or body against whom the complaint is lodged (Respondent)

Respondent’s email address (if applicable/known)

Nature of the relationship between the complainant and the respondent*

Nature of Complaint *

Have you previously lodged a complaint against the respondent for the same matter?*
—Please choose an option—YesNo

If a reference number was provided, please specify

The relevant date(s) on which the events occurred*

The place where the events occurred

Description of Complaint

Background Information*

What are you not happy with?*

Please attach any documents that you think will assist in resolving your complaint (Max size per file: 3MB)

What outcome do you desire?*

Declaration

• I hereby give CBE permission to investigate my complaint and to obtain all information necessary for purposes of resolving the complaint.

• I declare that the information provided in this form is true and correct to the best of my knowledge.

• I understand that to resolve my complaint, it will be necessary for the CBE to utilise, retain and process my personal information.

• I give consent to the CBE to refer and disclose any information submitted by me to any other office or stakeholder with jurisdiction in the event that the complaint does not fall within the CBE mandate.

Disclaimer

Please note that any personal information that you have or may disclose to or share with the CBE in this form or pursuant to anything advertised or otherwise published by the CBE may be processed in terms of the Protection of Personal Information Act, No.4 of 2013 and Regulations promulgated thereunder (“POPI Act”). By disclosing or sharing your personal information, you are unconditionally consenting to the processing by the CBE, its stakeholders or partners of your personal information. Further, you declare that you have obtained all consents required by the POPI Act or any other law applicable in respect of all personal information you disclose. Thus, you hereby indemnify the CBE against any civil or criminal action, administrative fine or other penalty or loss that may arise as a result of processing any personal information that you disclose to the CBE. Should you wish to object to the processing of any of your personal information as aforesaid, please do so in writing to the email addresses provided above at any time. The CBE undertakes to process your personal information only as required by law and within the bounds of the POPI Act.

I have read and hereby agree to the declaration and disclaimer above.