Contact details of complainer: First Name *: Last name *: Phone Number *: Address *: Email *: Status *: victim interested party The respondent (individual/institution that has allegedly committed the discrimination act): Name of the respondent Contact details of respondent: Address *: Phone Number: When was the discrimination act committed? *: Describe the discrimination act you invoke (maxim 3000 characters) *: Select the protected ground *: race colour nationality ethnic origin language religion or beliefs sex age disability opinion political affiliation sexual orientation Any other similar criterion Area in which discrimination occurred *: goods and services available to the public labour access to education other What is the person or group of persons in a similar situation whom you can compare yourself/the victim can be compared with? * Who has witnessed the alleged discrimination act? * Are there any documents, statistics or expert opinions to prove the discrimination act? * List/attach them (doc, docx):
