Submit a complaint Policy number / Polisnommer: * Name & Surname / Naam & Van: (required) Residential address / Woonadres: * Postal address / Posadres: * Email / E-posadres: * Contact numbers / Kontaknommers: * H W C F Nature of complaint / Aard van klagte: * Claim / EisPremiums / PremiesService of Legalex / Diens van LegalexService of 3rd Party / Diens van 3de PartyThe Policy / Die PolisOther / Ander Particulars of complaint / Besonderhede van klagte: * Member signature / Lid handtekening : * Compliance LegalX Complaints Handling Framework LegalX Conflict of Interest Management Policy Forms Application Form Aansoekvorm