Mon05202013

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Make A Complaint

Date (*)
Select the date which you are making the complaint.
Full Name of complainant (or name of legal entity filling the complaint) : (*)
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On whose behalf are you submitting the complaint? (In cases where the complaint is filled on behalf of another legal or physical person): (*)
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Address (P.O. Box, or street and number): (*)
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Postal Code: (*)
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City / Village: (*)
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Telephone number/s: (*)
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Fax number:
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E-mail address:
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Identity Card number (registration number of legal entity): (*)
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Against which Authority are you filling a complaint?: (*)
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Briefly describe your complaint (If the space provided is not sufficient, you may submit additional pages):
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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):
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