Full Name:
Email Address:
Phone Number:
Insurance App Name & Version:
Device Type:
Device Model & OS Version:
Marketplace Where App Was Downloaded:
Type of Issue: (Select all that apply)
Login/Authentication Problem
App Crashing/Freezing
Payment/Billing Issue
Policy Management Problem
Claims Submission Issue
Document Upload Failure
Slow Performance/Loading
Missing/Incorrect Data
Notification Problems
Other:
When Did the Issue Start?
Today
Within the Last 7 Days
More Than a Week Ago
After Recent App Update
Steps to Reproduce the Issue:
(Describe exactly what you were doing when the problem occurred. Example: "Tried to upload a claim photo, but the app froze.")
Error Message Received (if any):
(Please provide the exact wording or screenshot if possible.)
Is the Issue Consistent or Intermittent?
Happens Every Time
Occurs Randomly
Have You Tried Any Troubleshooting Steps? (Select all that apply)
Restarted the App
Restarted the Device
Reinstalled the App
Cleared Cache/Data
Checked for Updates
None
Policy Number (Optional):
Are You Logged In When the Issue Occurs?
Yes
No
Issue Prevents Login
Does the Issue Occur on Both Mobile & Web (if applicable)?
Only on Mobile App
Only on Website
Both
Screenshots/Recordings:
(Attach files showing the problem if possible. Max 5MB per file.)
Description / File Name | Upload File | ||
|---|---|---|---|
A | B | ||
1 | |||
2 | |||
3 | |||
4 | |||
5 |
Any Other Details That Might Help?
By submitting this form, I confirm that the information provided is accurate and consent to the support team contacting me for further assistance if needed.
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