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PUBLIC ASSISTANCE DEPARTMENT (PAD) ONLINE COMPLAINT FORM   

DEPOSITOR CORNER
Last Name First Name   MI
Postal Address
Age Contact Number Email Address
Complaint for LIVE BANKSComplaint for CLOSED BANKS
Name of Live Bank
Date Incident Happened
Nature of Complaint : (Please check appropriate box)
ATM-Related
No Cash Dispensed Card Captured
Short Cash Dispensed
Regular Deposit Account
Unserviced Withdrawal Unauthorized Withdrawal
Others: (Please specify)
Brief narration of complaint:
Name of Closed Bank
Nature of Complaint : (Please check appropriate box)
Claims-Related
To File Claim         To Inquire
To Receive Check
To Follow-up Claim (entry for Stub No. & Date Filed)
     Claim Stub No.
     Date Filed       
Others: (Please specify)
Brief narration of complaint:
  
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