DMA Grievance Request

Grievance Form

This form is to be used to file a formal grievance. All sections must be completed and will serve as the source document for the grievance process. Please answer all questions fully. All supporting documentation must be attached to this grievance form at the time the grievance is filed. Additional information may be requested as necessary.

Grievant Information

Company Name

Contact Person’s Name *

Address *

Contact Number* *

Email* *

Order/Decision Receipt Date *

State in this paragraph whether the grievant is an association, corporation, firm, or partnership, and if a firm or partnership, the names of the individuals composing the same. State the nature and principal place of business

Grievant Type

Shipper/consignee

Service provider

Other

Please attach a copy of the valid license to provide Sea Container Services in the Emirate of Dubai (if status is selected as Service Provider)

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Basis of grievance

Unsatisfactory resolution to complaint

Unsatisfactory Order/decision

Preferred method to contact:

Phone call

Details of Event Leading to Grievance:

(provide a detailed statement of the grounds of the grievance, use attachments if necessary)

Attach any relevant documents or evidence:

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Violations:

(Provide a list of any policies, procedures and guidelines you believe have been violated in the event described. How have you been adversely affected by this situation?)

Desired solution:

Additional Comments

(Any additional comments or information related to the grievance)

I hereby declare that the information furnished above is true, complete and correct to the best of my knowledge and belief. I understand that in the event my information being found false or incorrect at any stage, it could result in disciplinary action against me / the organization represented by me and the grievance shall be liable to cancellation / termination without notice or any compensation in lieu thereof.

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