Complaints

COMPLAINT ON THE ISSUANCE OF HANDOUT

(To be filled out by complainant)

1 of 5

Complainant Information

Name of Complainant (Candidate/Political Party/Body/Person)

Position (if lodging a complaint on behalf of a political party)

Physical Address

Postal Address

Phone

Email Address

Particulars of the Person Who Issued the Handout

Name

Physical Address

Phone

Postal Address

Email Address

Particulars of Recipient(s) of Handout

Name

Physical Address

Phone

Postal Address

Email Address

Handout Details

Place where handout was issued

Date when handout was issued

Description of Handout

Aim for at least 100 words for a complete description.

Purpose/Context of Handout

Additional Information/Comments

Confidentiality and Declaration

If you do not wish your identity to be disclosed to any party, please indicate this and explain the reasons

Yes, disclose my identityNo, do not disclose my identity

Reason for non-disclosure

I declare that the information provided in this report is accurate and complete to the best of my knowledge and belief.

I agree to the above declaration

Signature

Type your name or draw your signature.

Date

GENERAL COMPLAINT

(reg. 2(2))

1 of 5

Complainant Details

Name of complainant

Name of authorized representative of the complainant (if any)

Address of complainant or authorized representative

Phone number of complainant or authorized representative

Email address of complainant or authorized representative, if available

Representation Details

If the complainant is represented by a third party, provide a copy of documentation confirming that the representative is duly appointed by the complainant for representation in all matters relating to the complaint and any investigation by the Registrar

Click to choose a fileor drag & drop PDF,DOC,DOCX,JPG,JPEG,PNG here

Accepted formats: PDF, DOC, DOCX, JPG, PNG. Maximum size: 512 MB.

Complaint Details

Description of the alleged violation and supporting documentary evidence

Please provide as much detail as possible.

Third Party Information

Name(s) and address(es), phone number(s) and email address(es) of any relevant third party(ies) that may have information about the alleged violation

Confidentiality & Certification

If you do not wish your identity to be disclosed to any party, please indicate this and explain the reasons

Yes, disclose my identityNo, do not disclose my identity

Reason for non-disclosure

I hereby certify that, to the best of my knowledge, the provided information is true and accurate.

I agree to the above certification

Complainant's first name

Middle name/initial

Complainant's surname

Representative's name (if applicable)

Signature of complainant/representative

Type your name or draw your signature.

Date