Complaint against a Government Department / Official’s Conduct

Government Department Name: GOVT_DEPT_NAME

 

Particulars of the Complainant

Name: ACCOUNT_FIRST_NAME ACCOUNT_LAST_NAME

Correspondence Address: ACCOUNT_ADDRESS_SINGLE_LINE

Telephone: COMPLAINANT_PHONE_NUMBER

E-mail: ACCOUNT_EMAIL

Details of the Complaint

Name of Government Official Involved: GOVT_OFFICIAL_NAME

Name of Government Unit: GOVT_UNIT_NAME

Date of the Incident: INCIDENT_DATE

Case No.: (if applicable) CASE_NUMBER

Complaint Details:

COMPLAINT_DETAILS

 

(Please provide relevant supporting documents and use separate sheets if necessary.)

 

Declaration

I declare that the details provided in my complaint are true.

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