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Public Complaint Form

 

Name:  
I.C/Passport No.  
Address:
Happening Place/District:  
Telephone No.:  
Fax No.:  
E-Mail:  
Occupation:

(If 'Other' selected, please enter occupation above)
Gender:
Age:  
Race:
Nationality:
Complained Department:(Please choose Lain-lain for privatized govt. agency)  
Name of Complained Privatized govt. agency:
 
Categories of Complaint:

Any resolution efforts made?
If there are, please enter name of contacted officer or department

Complaint Title:  
Complaint Info:

 

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