Complaints Form – PanSALB

Linguistic Human Rights Violation Complaints Form

Your Details

Name, Surname & Age (required)

Telephone numbers (required)

Your email (required)

Address (required)

Nationality / Citizen Status (Please Specify)

I.D Number (required)

Details of the Person in the event the complaint is lodged on behalf of that person/organisation

Name, Surname & Age (required)

Telephone numbers (required)

Email (required)

Address (required)

Nationality / Citizen Status (Please Specify)

State Your Complaint

The complaint is against (Name, Surname if its natural person & Name if its Organ of the State , Juristic person or any Organization contact details) . If you don’t know the names, please tell us anything you know about them

In Your Own Words, Tell Us Exactly What Happened. Include All The Information You Think Is Important

(Please be free to attach as annexure if your information regarding the circumstances of your cannot be fully completed in this section)

Have you reported this case to anyone else?

YesNo

If so, who?
(For example, - Police, Lawyers, Public Protector, Human Rights Commission, Commission on Gender Equality, Land Claims, South African Heritage Resources Agency, Provincial Heritage Resources

Consent: Can we use your name in news reports or letters we write for you?

YesNo

Once you have filled in this form, please post, fax, email or whatsApp it to any of the PanSALB Offices throughout the country. Please note the contact details attached hereto Annexure A

Thank you for filling in this form. We will get back to you as soon as possible. If you have any queries, please call us and ask to speak to someone in the Linguistic Human Rights Unit