MEMBER FEEDBACK FORM Please rate the quality of service provided by checking the most appropriate column using the following rating scale: Name Date Visited Branch Visited Transaction Loan Deposit Withdrawal Loan Payment Inquiry Others Others, specify 1. Employee Provides immediate attention 5 – Very Satisfied 4 – Satisfied 3 – Neutral 2 – Unsatisfied 1 – Very Unsatisfied 2. Client’s needs are properly addressed or attended to 5 – Very Satisfied 4 – Satisfied 3 – Neutral 2 – Unsatisfied 1 – Very Unsatisfied 3. Employee is polite, respectful and accommodating 5 – Very Satisfied 4 – Satisfied 3 – Neutral 2 – Unsatisfied 1 – Very Unsatisfied 4. Employee’s instruction is simple & clear 5 – Very Satisfied 4 – Satisfied 3 – Neutral 2 – Unsatisfied 1 – Very Unsatisfied 5. Service rendered is complete & accurate 5 – Very Satisfied 4 – Satisfied 3 – Neutral 2 – Unsatisfied 1 – Very Unsatisfied 6. Employee’s workplace is neat & orderly 5 – Very Satisfied 4 – Satisfied 3 – Neutral 2 – Unsatisfied 1 – Very Unsatisfied OVERALL LEVEL OF SATISFACTION OF SERVICE (S) 5 – Very Satisfied 4 – Satisfied 3 – Neutral 2 – Unsatisfied 1 – Very Unsatisfied COMMENTS/SUGGESTIONS: Send Every Member’s Voice Matters.