Public Protector Act, 1994 (Act No. 23 of 1994)

Rules

Amendment Rules relating to Investigations by the Public Protector and Matters Incidental thereto, 2020

Annexures

Annexure A : Public Protector Complaint Form

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Annexure A

PUBLIC PROTECTOR COMPLAINT FORM

RE: COMPLAINT IN TERMS OF SECTION 6(1)(a) PUBLIC PROTECTOR ACT, 1994

FOR OFFICE USE

FiIe Number ...........................................

BP Number ..............................................

Date received ..........................................

Received by.............................................

Institution(s): .............................................

Subject: ......................................................

Jurisdiction: Yes No Undecided

Request for urgency: Yes No

1. PERSONAL DETAILS

Full Names and Surname: ..........................................................................................

Title ............Gender ........................ID Number.........................................................

Pension / Persal Number (if relevant)

Residential Address:

..................................................................................................................................

Postal Address: .........................................................................................................

City: ...................................Province: .................................Postal Code ...................

Telephone Phone No: ......................Home ................. Work ....................

Cell..................... Other...................................

(include area code)

Alternate Phone No: ....................Home ................. Work .......................

Cell...................... Other...................................

(include area code)

Fax No: ........................................Email Address: .......................................................

(include area code)

If this complaint is for someone else, please provide their details:

Name ...................................................ID Number.....................................................

Telephone Phone No: .............................. Cell No ........................Gender ................

Address: .....................................................................................................................

2. YOUR COMPLAINT

2.1 How did you hear about the Office of the Public Protector?

Radio............................Newspaper.......................Poster.............................

Friend.......................... TV....................................Other..............................

2.2 When did you first become aware of the problem:

Date .....................Month ...........................year .....................................

If it is more than 2 years since you first became aware of the problem, please give reasons why you did not complain to the Office of Public Protector earlier.

......................................................................................................................................

2.3 Which government agency is involved? (Please identify by specific name)

......................................................................................................................................

2.4 Whom have you dealt with at the government agency?

(List any names, titles, Tel numbers or addresses and state when last did you contact them)

......................................................................................................................................

2.5 Did you write to them/ did you receive any correspondence in writing?

.........Yes ........No

(if yes please attach copies)

2.6 Please summarize your complaint.

......................................................................................................................................

2.7 Please tell us about the steps you have taken to try and resolve this matter

(Please indicate any file or reference numbers and relevant dates)

......................................................................................................................................

2.8 Did you report this matter to any other government agency?

(e.g. Police, ICD, the Presidential Hotline, etc) ........Yes .........No

If yes, what was the result?

......................................................................................................................................

2.9 Why do you believe the government agency's actions are unfair or improper?

......................................................................................................................................

2.10 Describe how you would like the Office of the Public Protector to help you?

......................................................................................................................................

2.11 If you consider the matter urgent, explain why.

......................................................................................................................................

3. COMMENTS BY THE INVESTIGATOR (IF ANY)(FOR OFFICE USE)

......................................................................................................................................

Complainant' signature: _________________________

Date: __________________

SEND YOUR COMPLAINT FORM TO: OR HAND DELIVER TO:

The Office of the Public Protector

Private Bag X677

Pretoria 0001

Public Protector House, Hillcrest Office Park

175 Lunnon Road

Hillcrest, Pretoria, 0001

Public Protector Act, 1994 (Act No. 23 of 1994)

Rules

Amendment Rules relating to Investigations by the Public Protector and Matters Incidental thereto, 2020

Annexures

Annexure A : Public Protector Complaint Form

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