Public Service Commission Act, 1997 (Act No. 46 of 1997)

Rules

Purchase

Annexure A

FORM FOR LODGING A COMPLAINT WITH THE PUBLIC SERVICE COMMISSION

1.	Particulars of complainant:

Full names:

Postal address:

Code:

Street address:

Code:

Telephone number:

Cellphone number:

Fax number:

e-mail address:

2. Particulars of the complaint: (use additional pages if necessary and attach all relevant documentation)

Place of occurrence:

Date of the occurrence:

Names and designations of official(s) involved:

Department(s) involved:

The nature of the complaint (background and history):

Steps, if any, taken to endeavour to resolve the complaint:

The names and particulars of those in the department who may have been dealing with the complaint:

With which other institution(s) was the complaint lodged and what was the outcome?

The names, contact numbers and addresses of any person who could provide information relevant to the complaint:

The outcome sought to be achieved by the investigation:

List of supporting documentation (as attached):

The method in which the complaint was lodged with the PSC:

(a) Form completed by complainant o

(b) Letter or statement posted, e-mailed, SMSed of faxed o

(d) Verbally in person o

Signature of complainant completing the form:

Date:

Name and contact particulars of the employee of the OPSC who collated the information