CET Scope Issue Report Form

Form Details:

• Assigned:

• Updated:

• Form Reference:

Claim Information:

• CET Reference:

• Insured Name:

• Client:

• Date Of Complaint:

• Repair Team:

• Repair Leader:

• Date Of Visit:

• Time:

• Present During Visit:

• Address:
  Address

• Contact Tel No:

• Description of Complaint / Concern:

Repair Team Comments:

• Add media

  Media

Repair Leaders Findings:

• Add media

  Media

Resolution:

• Resolution Date Agreed?

  Yes

  No

  N/A

• Resolution Date:

  Date

• All Parties Aware of the Dates?

  Yes

  No

  N/A

• Concerns / Complaints Justified:

• Is Compensation Due?

  Yes

  No

  N/A

• If Yes, Who are we receiving monies from?

Additional Information:

Signatures:

• CET Representative:

  Sign

• Insured / Representative:

  Sign