投诉表格范本英文ModelComplaintForm.docVIP

Model Complaint Form For communications under: Optional Protocol to the International Covenant on Civil and Political Rights Convention against Torture, or International Convention on the Elimination of Racial Discrimination Please indicate which of the above procedures you are invoking: ……… Date: …………. I. Information on the complainant: Name: ……… First name(s): …………. Nationality: ……… Date and place of birth: …………. Address for correspondence on this complaint: ……….. Submitting the communication: on his/her own behalf: ……….. on behalf of another person: ……….. If the complaint is being submitted on behalf of another person: Please provide the following personal details of that other person Name: ……… First name(s): ……….. Nationality: ……… Date and place of birth: ……….. Address or current whereabouts: ………. If you are acting with the knowledge and consent of that person, please provide that person’s authorization for you to bring this complaint ………… Or If you are not so authorized, please explain the nature of your relationship with that person: ……………… and detail why you consider it appropriate to bring this complaint on his or her behalf: ………….. II. State concerned/Articles violated Name of the State against which the complaint is directed: ………… Articles of the Covenant or Convention alleged to have been violated: ………… III. Exhaustion of domestic remedies/Application to other international procedures Steps taken by or on behalf of the alleged victims to obtain redress within the State concerned for the alleged violation – detail which procedures have been pursued, including recourse to the courts and other public authorities, which claims you have made, at which times, and with which outcomes: ………………….. If you have not exhausted these remedies on the basis that their application would be unduly prolonged, that they would not be effective, that they are not available to you, or for any other reason,