Part 1: Your Details

Number:

Rank:

Name:

Current Posting:

Unit:

Home Address:

Email Address:

Home Phone Number:

Work phone Number:

Mobile Number:

Contact Type:

Part 2: Your Complaint is all about

The action you wish to complain about:

Please give details of the action you wish to complain about and your posting at the time of the action.

The negative afect of the action:

Please give a short outline how this action has adversely affected you.

The date when the action took place:

Please give the date when the action took place or when you became aware of it.

Person or people responsible for the action:

Please provide details of the person or people responsible for the action. If they are military personnel please include their rank.

The internal complaint procedure:

If you are a serving member of the Defence Forces or the Reserve Defence Forces please give the date when you made a complaint through the internal military complaints procedure. Also outline any outcome from that process and why you believe that this response is inadequate.

Supporting Documentation:

Please give details of any supporting documentation you are including with this complaint.

Any other Information:

Use this section to give any other information that you think applies to your complaint.

Date:

Please give the date when you completed this form.