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?