Part I : Particulars of aggrieved person
I would like to lodge a complaint of discrimination under the
Part II : Please fill in this part if the aggrieved person is assisted by a representative
Particulars of representative
I hereby appoint the following person as my representative to assist me to handle my complaint.
Part III : Particulars of Respondent(s) (individual / organization)
Part IV : The Complaint
1. Your allegation(s). (Please include concerned person(s), time, date, location, incident and effects on you). Information given in this part will be given to the Respondent(s) (individual / organization) for comments.
2. The information provided by the Aggrieved Person in this complaint form is true to the best of the person's knowledge.
Must be filled in
3. Document(s) supporting your allegation(s) (e.g. proof of disability)
4. Witness(es) available
5. I have the following special request(s):
Part V : Authorization
I authorize the Equal Opportunities Commission to obtain information from the Respondent to facilitate the investigation into my complaint(s) lodged under the Disability/Sex/Family Status/Race Discrimination Ordinance.
Remark: All personal data submitted will only be used for purposes related to the carrying out of the statutory functions of the EOC, including conducting research for service improvements. Data subjects have the right to request access to and correction of their personal data submitted for this complaint. Formal requests under the Personal Data (Privacy) Ordinance should be submitted in writing to the Director (Planning & Administration) at the EOC address. The personal data submitted may be transferred to parties or agents engaged by the EOC for the above-mentioned purposes. The information provided might also be disclosed to agencies who are authorised to receive information relating to law enforcement. The original of this complaint form and any material provided will be at the disposal of the EOC and normally will not be returned to the complainant.