Send Complaint

Complaint Form

PART A ( COMPLAINT INFORMATION)

Complaint's Name *

Age *

Sex *

Occupation

Marital Status *

Address ( Not P.O.Box ) *

Mobile *

E-Mail *

Nationality *
PART B ( VICTIM'S INFORMATION IF DIFFERENT FROM ABOVE)

Victim's Name *

Age *

Sex *

Occupation *

Marital Status *

Contact Address (Not P.O.Box) *

Mobile *

E-Mail *

Nationality *

Other Victim's Detail: Name, Age, Sex, Occupation, Marital Status, Address, Mobile, EMail, Nationality
PART 3 ( ALLEGED VIOLATOR(S) )

Name *

Organization

Address *

Mobile *

E-Mail *
PART 4 (LOCATION OF INCIDENT)

Location of Incident *

Date

Time *

Street Address, Town/Village. LGA, State *
PART 5 (NATURE OF COMPLAINT)

List the complaints you have *

Describe how the violations happened *

List Witness(s) Name, Address, Mobile
Do you have any supporting document(s) to backup your story? Please upload it here.

Upload

has this complaint been reported to any other organization e.g Police, Court, PCC, NGO, Community Head etc. Please specify if any.

What are the actions taken? (if any)

Has there been any violations in the past?

What do you wan the commission to do?