Complaint Form

YOUR INFORMATION

First Name *

Last Name *

Mailing Address

Address Line 1 *

Address Line 2

City *

Country *

Province/State *

Province/State

Postal/Zip *

Phone Number *

Email Address *

FUNERAL SERVICES BUSINESS INFORMATION

Please enter the name of the Business

My Concern is with *

Name of the Person you were dealing with/speaking to *

NATURE OF CONCERN/COMPLAINT

Is this concern regarding a funeral? *

Yes

Name of deceased

Date of Death

Date of Funeral

Were you responsible for the funeral arrangements *

Yes

Is this concern regarding funeral goods or services? *

Yes

Is this concern regarding a pre-need contract? *

Yes

My concern is not listed above and is regarding

DETAILS

Please provide details of your concern

What steps have you taken to resolve the concern?
identify who you contacted.

Have you filed or do you intend to file any other complaints or have you started any other proceedings concerning this complaint?
If yes, please explain.

What would you like the business to do?
How can this concern be resolved for you?

How did you hear about the AFSRB?

DOCUMENTS

Please attach copies of any paperwork that is related to and supports your position (i.e. letters, emails, contracts, bill of sale, cancelled cheques, etc.).

Upload Document

Signature *

Date *

Users