The Office of the Commissioner for Administration (Ombudsman)

(It is necessary to complete all parts of the complaint form, which are marked with an asterisk. The information provided will be used only for the purposes of the investigation of your complaint.)

Complaint_Form_EN.pdf

Complaint Form

Date :		23/05/2013

Full Name of complainant (or name of legal entity filling the complaint) :	*

On whose behalf are you submitting the complaint? (In cases where the complaint is filled on behalf of another legal or physical person) :	*

Address (P.O. Box, or street and number):	*

Postal Code:	*

City / Village:	*

District:	*

Telephone number/s:

Fax number:

E-mail address:

Identity Card number (registration number of legal entity):	*

Social Security number (for physical persons only):




Against which Authority are you filling a complaint?:

Briefly describe your complaint
(If the space provided is not sufficient, you may submit additional pages) :

Prior to contacting the Ombudsman did you refer the matter to the Authority concerned? If yes, what was the response (Attach copies of all related documents) :

Is your complaint the object of a hierarchical recourse or part of a case pending in a court of law? If yes, please give more details (e.g. number and case information) :

Fields with * are mandatory.

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