Comments/Complaints/Request for an Appeal Entry Form

Entry of the comments / complaints / appeals
Name(*)
Email address(*)
Occupation (Position)
Address(*)
Phone number(*)
Fax number
Area to be reviewed(*)	Please check the item that applies- Comments or complaints on JQA's assessment services Comments or complaints on the organization or entity that JQA provided the assessment services Appeals
Object to be reviewed(*)
Date of occurrence(*)
Site of occurrence(*)
Subject matters in specific(*) (Maximum 2000 letters)	0 letters

* On condition that all the items are clearly filled in, we will respond in accordance with "Rules to handle Complaints, Appeals, and Disputes"(JQA may not respond if we find any false statement.)
* Your personal information will be used only for contacting on this issue. We will not disclose personal information to a third party without the consent of the individual.
In addition, your personal information shall be managed under the laws, regulations and the internal rules of JQA.

*When you send the form by post, please print out the confirmation screen after clicking Confirm button.