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Specific Complaint Form


Please use this form if you would like to make a specific complaint about the service provided by the Social Security Agency (Northern Ireland Only). We need you to fill in the fields marked with * so that we can reply to you. If you give us your email address as well we can reply quicker.
Title
First name *
Surname *
Address Line 1 *
Address Line 2  
Town / City *
Postcode  
Telephone  
Email address Please check spelling
 
Details of your Complaint   Note: Email is not secure - please no do not enter personal information.
 
Is this your first contact
with us regarding this
complaint?		 Yes No
 
If NO, who have you
previously contacted?		  
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