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Complaint concerning the services delivered by the personnel of the RBQ

Complete the form

The fields preceded by an asterisk ( * ) are mandatory.

1. Your details

*This field is mandatory.Last name

*This field is mandatory.First name

RBQ licence number (if any and if known) (1234-5678-99)

*This field is mandatory.Telephone number (555 666-7777)

Extension

Other telephone number (555 666-7777)

Extension

*This field is mandatory.E-mail address

*This field is mandatory.Please confirm e-mail address

2. Description of your complaint

*This field is mandatory.Describe in a few words the facts that you wish to report.

Print the form before sending it and keep your copy for reference.

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