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I, the undersigned hereby confirm, acknowledge and authorise that the Office of Consumer Protector- KZN to endorse my particulars in their internal complaint form.

This will enable the personnel of the Consumer Protector-KZN to utilise the information, statements, reports, prior regulators recommendations and any other documents that I had written or provided to above mentioned entity,to facilitate , handle, mediate and further investigate my complaint.

The information will be used for the purposes of lodging a complaint with Office of the Consumer Protector-KZN and communication referred to the defendants whom I complained against in order to ensure that my complaint is investigated in terms of the KwaZulu Natal Consumer Protection Act 04 of 2013.

All information in the fields marked with a red asterisk (*) are compulsory fields and must be completed.