Complaint form

Particulars of authorised representative

I hereby appoint the following person as my representative to assist me in handling my complaint.

Full name

Representative Email

Representative Phone

Reason(s) to appoint an authorised representative

Relationship

eg. Friend, Legal Representative, Relatives, Employer-Employee, Colleagues, Spouse

Correspondence address

Particulars of respondent

Respondent Name

* Name of party complained against

* Phone no.

Email address

*Correspondence address

The complaint

* Please state your allegation(s). (Please include any concerned person(s), date, time, location, incident and effects on you.)

The information provided by the aggrieved person in this complaint form is true to the best of the person's knowledge.

Any supporting documents?

(Up to 3 attachments, only files in PDF/ DOCX / DOC / JPG / PNG / JPEG formats can be accepted. File size of each attachment should not exceed 4 MB.)

Choose file for File 1

Choose file for File 2

Choose file for File 3

Any special requests?

(e.g. Mail should be sent to me by registered mail)

Authorisation

* Please check the boxes:

I understand that by submitting this complaint form, my statement of complaint and/or supplementary information may be passed to the respondent for information and response where necessary.

I authorise the Equal Opportunities Commission to obtain information from the respondent to facilitate the handling of my complaint(s) lodged under the Sex/ Disability/ Family Status/ Race Discrimination laws.

I have read and understood the "Points to Note" and allow the EOC to use my personal data collected in accordance with the purposes specified above, and that the EOC may disclose personal information collected to parties relevant to the complaint, or transfer it to authorised person(s).