Complaint form

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Complaint form

To the People’s Advocate,

First name and surname (capital letters) ……………………………………….., domicile (residence or another address where you can be contacted) …………………………….. St. ………………………………………….. No. ….. Bl. ….. Sc. ….. Apt. ….., County/Sector ………………………………..Telephone …………….
The date when you learned about the violation of your rights: ………………………………………………………………………………………………………………..
Brief presentation of the rights and/or freedoms violated:

………………………………………………………………………………………………………………..

The denounced administrative authority and/or the civil servant: ………………………………………………………………………………………………………………..

………………………………………………………………………………………………………………..

Brief presentation of the alleged maladministration: (you may continue on another page and attach it to the application)

………………………………………………………………………………………………………………..

The public authorities notified before:

………………………………………………………………………………………………………………..

7.The answer received and the grounds on which you deem yourself further wronged: ………………………………………………………………………………………………………………………………………………………………………………………………………………………………….

………………………………………………………………………………………………………………..

In sustaining the alleged facts, I submit the following documents (copies, not originals): ………………………………………………………………………………………………………………..

………………………………………………………………………………………………………………..

The mandatory statement on whether the petition is/was the object of a litigation in a court of law:

YES/NO

I wish that all the information and the results shall remain confidential:

YES / No

The petition is submitted:

|_| Personally

|_| By delegate

Date ……………

Signature …………………

NEWS

Monitoring the observance of rights of the refugees from Ukraine

People’s Advocate – member of the I.O.I.

DG JUST – EU Charter of Fundamental Rights