Complaint form

Please only use this form if you have a complaint. To request cover or prior approval login to My Southern Cross or for other enquiries use the General Enquiry form.

* Indicates a required field

Membership number

First name

Last name

Date of birth

Daytime contact numberPlease note, in some circumstances we may need to contact you by phone to ensure that your complaint is progressed efficiently.

Home phone

Work phone

Mobile phone

Number/street

Suburb

Town/city

2. Complaint detail

Details

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Complaint form