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Emergency Line Fault Reporting

Please complete the form below regarding the problem you experienced with the emergency line.
Please note that this form applies to 084124 (South Africa) only.
Your Name*
Your Surname
Cellular Number*
Landline Number
E-mail*
Date*
Province*
From which province did you dial 084124?
Suburb / Town*
Physical Address
Time of Call*
AM/PM*     

Fault Reporting
From which number did you dial 084124?*
Did you attempt to call from another divice or landline?
If Yes, was your call answered?
How did you attempt to call 084124?*
Please select the device or platform you utilised to contact 084124. If you dialed from a company - can you normally dial short codes?
Who is your service provider
(the number you dialed from)
  Did you experience any of the following during the call?
Why did you contact 084124?
I you did speak to an emergency call taker, how was their service?
Questions or comments