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BIL - Complaint Form
Date of request:
2024-04-29
Contact details
Title (Required)
*
Title
Mr.
Mrs.
Surname (Required)
*
Surname
Firstname(s) (Required)
*
Firstname(s)
BIL account number (IBAN format)
BIL account number (IBAN format)
Email (Required)
*
Email
Phone number (international format, e.g.: +352 XXX XXX XXX) (Required)
*
Phone number (international format, e.g.: +352 XXX XXX XXX)
Date of birth (Format: yyyy-mm-dd. The minimum date is '1924-04-29'. The maximum date is '2006-04-29'. Required)
*
Date of birth
Address (Required)
*
Address
Town/city (Required)
*
Town/city
Country (Required)
*
Country
*
Mandatory fields
