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Consumer Complaint Form


Reference: 
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
E-mail:  disbcomplaints@dc.gov
Attachment(s): 
AttachmentSize
Consumer Complaint Form Mail-in Version96.04 KB