Consumer Complaint Form
Form # CCF1 Rev. 1/13
Please take the time to read these guidelines because following them will allow us to better serve you.
- Please complete the consumer complaint form as thoroughly as possible.
- Please attach supporting documentation.
- Please sign the consumer complaint form upon completion.
- Please retain a copy including any original documentation for your files.
- Please return the form by mail, fax, e-mail, or hand delivery to the following address:
District of Columbia Department of Insurance, Securities and Banking
810 First St., NE, Suite 701
Washington, DC 20002
Fax: (202) 354-1085