Try the "YP App complain box"

Hello:
You are invited to participate in our survey. The survey is for our marketing management course where we are doing a research on developing a new app in Bangladesh. The app is generally designed to be a complain box where all the email address of Government and Private Organisation will be given. People have to select the organisation like any restaurant or hotel or even BRTA for traffic jam. They can easily send the mail to the selected organisation within a moment by using their smartphones. People don't have to visit the place or send the mail from PC.
In this survey, people will be asked to complete a survey. It will take approximately [5] minutes to complete the questionnaire.

Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.

Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact [Name of Survey Researcher] at [Phone Number] or by email at the email address specified below.

Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.

I Agree