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Complaint form

Complaint Form

Note: Fields marked with an asterisk (*) are required.

Particulars of aggrieved person
* I would like to lodge a complaint of discrimination under the following Discrimination Laws(s):
* Full Name
* National Id (NIN) / Passport NO
* Contacts
  1. Please provide all of the following means of contact if possible to facilitate our follow-up work. Providing accurate contact details will enable us to follow up with you promptly and effectively.
  2. If more than one mode of written communication is provided, please indicate your preferred mode of written communication in the option below.
  3. If you need an acknowledgement and a copy of the submitted online form, please provide your email address. If you authorise a representative and provide the representative’s email address, we will send the acknowledgement and a copy of the submitted form directly to the representative.
* Phone number
Email address
*Correspondence address
Particulars of respondent
* 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.)
Any special requests?
(e.g. Mail should be sent to me by registered mail)
* Please check the boxes: