Dispute resolution request form
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Please note: It is ASIAL's policy that before dispute resolution can begin you must put your complaint in writing to the ASIAL member describing your grievance and the result you want to achieve. View policy
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Checklist:
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- Have you put your dispute/complaint in writing to the ASIAL member? Letter template is provided
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- If you have put your dispute/complaint in writing and have not received a response within 21 days or you are not satisfied with the members response you may complete the complaints/dispute form below.
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|  | | | Other title (if appropriate):
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| | | | | | Are you making this application on behalf of a company?
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| | If yes, what is the full name of the company, including ACN/ABN?
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| | | | Address for correspondence
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| | | | | | | | | | | | Other state/territory (if appropriate):
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| | | | | | Business hours phone number:*
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| | Alternate contact number:
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| | | | | | Product/service description:*
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| | | | Time, date and place where the product/service was provided:*
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| | Brief description of the complaint (limited to approx. 20 lines, 3000 characters with spaces):*
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| | Have you written to the provider to lodge a formal complaint?*
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| | If yes, what was the outcome?
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| | What outcome do you want?
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| | Please enter the text you see appearing in the box:
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| | *indicates mandatory fields
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Frivolous complaints
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ASIAL will not take action on any complaints that are deemed to be frivolous, vexatious or not made in good faith.
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Disclaimer
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ASIAL cannot guarantee the security of any exchange of information. If you are concerned about providing your request for dispute resolution online, you can print this form and post or fax it to ASIAL.
Mail to: ASIAL, PO Box 1338, NSW 1585
Fax to: 02 84254343
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