Case Intake — The Gurus Compliance

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Full name

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Email address

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Phone number

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NPN (if applicable)

Company / Agency

Position / Title

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Complaint details

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Complaint category (check all that apply)

Unauthorized Enrollment — consumer says they never agreed Misleading Information / Misrepresentation TCPA / Do Not Call concern Identity theft / fraudulent use of information Plan/coverage misunderstanding or mismatch

Other

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Complaint source — who opened the case?

Consumer to carrier Department of Insurance (DOI) CMS / Federal Marketplace State Attorney General FMO / Upline

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Response deadline

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Carriers involved

Number of members affected

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Brief summary

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Evidence & documentation

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Documentation currently available (check all that apply)

Call recording showing the conversation and authorization Signed or electronic consent form IP capture / geolocation data from a web form Email or text thread where the consumer requested help Fact-finder or enrollment worksheet completed during the call Landing page form submission with timestamp Application confirmation email sent to the consumer None of the above — documentation will need to be recreated or supplemented

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Compliance Case Intake

Your information

Complaint details

Evidence & documentation

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Intake received!