Complaint Form

Victim Information

Your Email (required)

01. Title

MrMsRevOther

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)

FemaleMaleOther

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. Date of the occurrence of the alleged violation, provided is not enough, please attach additional document/s below)

12. Basis for Human Rights Violation if any (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. Whether this matter has 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?

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

Make a Complaint

Complaint Form

Victim Information

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

Respondent

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

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