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Your Details
Name of Complainant
*
Date of Birth
*
Date of Birth
*
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Gender
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Status
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Person with a Disability (PWD)
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Religion
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Your Location
Village/LC1
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District
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Your Contact Details
Telephone
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Email
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Postal Address
Your Next of Kin
Name of Next of Kin
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Address of Next of Kin
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Your Documentation
Upload a copy of your Identity Card
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Upload your passport photograph
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The Complaint
Nature of Complaint
*
Please explain as clearly as possible what happened, why you believe it happened, and how you were discriminated against. Indicate who was involved. Please include how other persons were treated differently from you.
Rights Violated
*
Person/Entity/Organisation being complained against
Name of Entity
*
Telephone of Entity
*
Email of Entity
*
Address of Entity
*
Date when breach occured
*
Date when breach occured
*
Month
-Month
Jan
Feb
Mar
Apr
May
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-Day
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2
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-Year
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Is The Complaint /Matter Pending Before Any Court Or Tribunal
*
Yes
No
Have You Exhausted Internal/Domestic Remedies? If yes, give Details
*
Yes
No
Have You Sought Any Legal Representation/ Do You Have A Lawyer?
*
Yes
No
Remedies Sought / What Do You Want Eoc To Do For You
*
List Of Documents Attached/ List Of All Documents In Your Posession Relevant To This Complaint
Possible Witnesses
Please List Any Persons, Whom We May Contact For Additional Information To Support Or Clarify Your Complaint
Give Any Additional Information You Deem Relevant To This Complaint
Attach any other relevant documents
Attach any other relevant documents
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your local address phone
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Complaint ID
Complaint PDF
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