Complaint Form Reporting date select province select provinceCentral ProvinceCopperbelt ProvinceEastern ProvinceLuapula ProvinceLusaka ProvinceMuchinga ProvinceNorthern ProvinceNorth-Western ProvinceSouthern ProvinceWestern Province NRC/ID email Phone number age sex sexFemaleMale Name of complainant Physical address PWD/Type of disability PWD/Type of disability Albinism Autism Down syndrome Hearing Physical Psychological Visuals Intellectual Speech Impairment Marital status Marital statusmarriedsingledivorcedwidowwidowerseparated Level of education Level of educationnonepre-schoolprimarysecondarytertiary Employment status Employment statusunemployedemployedself-employedretired Name of employer Profession/position Purpose of visit (tick where necessary) Purpose of visit (tick where necessary)new complaintfollow up Type of complainant (tick where necessary) Type of complainant (tick where necessary)individualjointorganizationHRC initiativerepresentative Representative name(s) of aggrieved person, Org or members Representative's sex Representative's age nature of human rights violation (categorization of rights violated) nature of human rights violation (categorization of rights violated)Civil and political rightsESCRGroup rights Alleged violation/abuse Type of violator Type of violator state non state citizenship Nationality name of respondent telephone (if known) Address (if known) Nationality of respondent (if known) Person representing respondent (if known) Citizenship Nationality Complaint Witness name, address and contact number What do you want the witness No. 2 to be heard about? Attached copies of documents in support of Complaint You can upload a maximum of 4 items File InputChoose FilesNo Files ChosenAccepted file types: jpg, jpeg, jpe, gif, png, pdf, zip. Max. file size: 1 MB Other authorities etc. involved in the matter? Other authorities etc. involved in the matter?YesNo Have you filed a complaint or similar to any other authority organization/person in the same matter? If yes, which one? Have you filed a complaint or similar to any other authority organization/person in the same matter? If yes, which one? Have you filed a complaint or similar to any other authority organization/person in the same matter? What has been the result of that complaint? What has been the result of that complaint? Positive feedbackNegative feedbackProgressNo progress Have you complained to the Commission previously? Have you complained to the Commission previously?YesNo If yes when? How did you know about the commission? How did you know about the commission?TvRadioPrint mediaWebsiteFacebookTwitterWhatsAppPublic forumOther if other, specify if other, specifyTvRadioPrint mediaWebsiteFacebookTwitterWhatsAppPublic forumOther Lodging mode Lodging modeEmailFaxPhysicalPrint mediaPublic forumReferralSMSTelephoneWebsiteToll-free line To obtain legally binding consent from the user that they accept the rules of your website/service and how their data will be processed To obtain legally binding consent from the user that they accept the rules of your website/service and how their data will be processed "I agree to the Terms & Conditions." "I have read and agree to the Terms of Service." "I agree to the Terms & Conditions and Privacy Policy." Submit
