Please fill this form as accurately as possible. Your complaint will be assessed and you will be informed of the outcome even if the Human Rights Commission finds that it cannot investigate your case. Lack of necessary information may result in the rejection of your complaint. Please note that information regarding citizenship, ethnicity etc is required only if relevant due to allegations of racial discrimination or similar allegation. You are kindly requested to inform the Commission of any changes of address or telephone number or any circumstance relevant to an investigation of your complaint.
Name of Complainant
First Names
Surname
Organization Name
Age and Sex
Date of Birth
Sex:
Male Female
National Registration Card No.
Address
Street
Postal Box
City
Country (if other than Zambia)
Telephone
Mobile (Cellular) No.
Email Address
Employment
Employer (Name)
Profession/Position
Unemployed Retired Other
Citizenship etc. Information required only if relevant to your complaint, for instance if you believe that you have been discriminated against due to your ethnic or genealogical background.
Citizenship
Nationality
Ethnicity/Genealogical background (tribe)
Complainants Representative
Representatives Name
Profession
Particulars of Respondent
Name of Respondent
Address (if known)
Telephone (if known)
Person representing, respondent (if known)
Other information to identify respondent
Complaint
Alleged facts and date of alleged incidents and arguments
Please do not forget the date of the alleged facts
Particulars of possible witness(es)
Witnesses
Witness No. 1 Name
Office Telephone
What do you wish the witness to be heard about?
Witness No. 2 Name
Documents
Please email any supporting documents to phrc@zamnet.zm or mail them to our address at
The Director Human Rights House, Independence Avenue, Lusaka, Zambia P.O. Box 33812, Lusaka, Zambia
If relevant documents are not in your possession please describe them so that the Commission can find them if an investigation is undertaken.
Additional Information
Other authorities etc. involved in the matter
Have you filed a complaint or similar to any other authority organization/person in the same matter?
Yes No
If yes, which one?
when
What has been the result of that complaint?
Previous complaints to Commission
Have you complained to the Commission previously?
When
