Complaint Form

Victim Information

Your Email (required)

01. Title

Mr Mrs Miss Other

Name of Alleged Victim

02. Address of the Victim

03. National Identity Card Number

04. District

05(a). Phone No (if any)

05(b). WhatsApp No (if any)

06. Age

07. Sex (Female / Male / Other)

Female Male Other

08. If the Complaint is not lodged by the alleged victim:

08(a). Name of complainant

08(b). Address of complainant

08(c). Complainant Email

08(d). Phone No (if any)

08(e). WhatsApp No (if any)

08(f). Relationship to alleged victim?

Respondent

09. Against whom is the complaint being made?

09(a). Institution against which the complaint is being made (Ministry/Government Department/Public Corporation/A local Authority/ State Public Company/Institution)

09(b). Names, Designation and addresses of the officer alleged to be responsible for the alleged rights violation.

10. Please provide details of alleged violations (If the space provided is not enough, please attach additional document/s below)

11. What is the relief you seek regarding the current complaint?

12. Basis for Human Rights Violation (Race, Language, Religion, Sex, Personal, Administration, Political Opinion)

13. Evidence to be presented in support of your allegation

13(a). Witness names and details

13(b). Documentary evidence (attach)

Choose File 1

Choose File 2

Choose File 3

Choose File 4

Choose File 5

13(c). Other evidence (1–3)

Choose File 1

Choose File 2

Choose File 3

14. If this matter been referred to any court/ tribunal or commission before:

14(a). Name of the Court / Tribunal/ Commission

14(b). Date on which complaint was made

14(c). What was the outcome/present status of that complaint?

Make a Complaint

Complaint Form

Victim Information

08. If the Complaint is not lodged by the alleged victim:

Respondent

14. If this matter been referred to any court/ tribunal or commission before: