COMPLAINT FORM

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PROPERTY OWNER INFORMATION

Title Please Select ADMIRAL AIR CDRE AIR COMMODOR AIR MARSHAL ALFA ALHAJA ALHAJI ALHAJI AND MRS ALHAJI/ALHAJA Ambassador Apostle ARC ARCH ASIWAJU BARRISTER BISHOP BRIG. GENERAL CAPTAIN CHIEF CHIEF (MRS) Chief Dr CHIEF IMAM CHIEF(MR) COL COMMANDER COMMODOR DEACON DEACONESS DR DR & MRS. DR./MRS ELDER ENGR ESQ EVANG GEN. HON. HON. (CHIEF) HON. (DR) HRH IMMAM Inspector JUSTICE LAWYER Lt COLONEL LT. COL LT. COL.(RTD) MADAM MAJOR MAJOR GEN MALLAM MISS MR & MRS MR. MRS. MS MWO N/A OBA OLUWO OTUNBA PA PASTOR PASTOR/MRS PHARMACIST PRINCE PRINCESS PROF. PROPHET PROPHETESS REV REV. (MRS) REV. DR REV./MRS Rtd Rtd Major Rtd Navy RTD. AIR VICE MARSHAL RTD. GEN SENATOR SIR SNR APOSTLE SURVEYOR VEN. VISE AIR MARSHAL WING COMMANDER

Property owner's surname

Property owner's other names

Your own name (complainant's name)

Landlord's residential address

Property address as shown on demand notice you received

Enter correct address if different from above

Local Government Area Please Select Agege Ajeromi-Ifelodun Alimosho Amuwo Odofin Apapa Badagry Epe Eti-Osa Ibeju-Lekki Ifako-Ijaiye Ikeja Ikorodu Kosofe Lagos Island Lagos mainland Mushin Ojo Oshodi-Isolo Somolu Surulere

Phone number

Email address

Notice number

Have you completed a questionaire (Assessment Form) before? Please Select No Yes

Nature of Complaint

Request for Bill Valuation Issues Name and address correction Request for Exemption Classification Update Nature of occupation Penalty waiver/account reconciliation Issues Others

If your nature of complaint is not stated amongst the options, Kindly select "others", and provide additional information regarding the complaint.

Language Please select Yoruba English Hausa Igbo Pidgin

Additional Information

How should we send your Bill? Please Select Self collection Courier Email

Signature

Please enter your full name

ATTACHMENTS(optional and must be in JPEG format)

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