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Complaint form

Please, mention your identity and contact data:
* always fill in
First Name*:
Surname*:
(for ladies own surname)
Address*:
Postal code*:
City*:
Country*:
Phone number at work:
Private phone number:
Fax:
E-mail:
   
Do you want to submit a complaint on behalf of somebody else?

Please, first print the mandate form, fill it in, let it sign by the mandating person and send it back to the Office of the Pensions Ombudsman.

Please, mention your identity data at the Pensions Office concerned:

* always fill in
Name of the Pensions Office*:  
Your pension’s number:
(You will find it in each letter from the Pensions Office)
Your national number:
(You will find it on your identity card)
 
Your birth date*:  
 

 

Please, give a detailed description of your problem:

1. About which kind(s) of pension(s) do you want to submit a complaint?

Retirement pension
Survivor's pension
Pension for physical unfitness (civil servants)
Old-age annuity
Widow’s annuity
Income guarantee for the elderly
Other pension – Which one?

 

2. About which procedure do you want to submit a complaint?

 

3. About which decision do you want to submit a complaint?

 

4. What are the grounds for the complaint?

 

5. Did you try to resolve the problem with the concerned Pensions Office(s)?

By phone
By letter
On the spot

What answer did you get from the Pensions Office(s)?

 

6. Did you go to court for an administrative or legal proceeding (mark with a cross)?

Yes
No

 

If yes: at which date?
To which court?

 

Is a judgement passed?
Yes
No

 

7. Do you have other remarks or comments?