• [Personal detail] Name*

• Are you complaining on behalf of someone else?
• `Select...`;YesNo

• Please check the type of complaint, as relevant.
• • Children 
  • Discrimination 
  • Employment 
  • Other (please provide details below) 
  • Police misconduct / inaction 
  • Social welfare 
  • Violence and torture 
  • Right to Privacy 
  • Right to be free from removal and protection asylum-seekers 
  • Arbitrary Eviction 
  • Prison 
  • Rights of Arrested and Detained 
  • Migrant workers rights violated 
  • Tenancy 
  • Disability 
  • Access to Information 
  • Gender-based Violence 
  • Cruel and Degrading Treatment 
  • Freedom of Religion 
  • Elderly Abuse 

• If other type of complaint, please specify.

• Please provide details about the incident.
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• What kind of assistance/outcome do you want from the Commission? Please provide details.
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• [Personal detail] Age

• [Personal detail] Age range
• `Select...`;0-1718-3536-64>65

• [Personal detail] Ethnicity
• • Rotuman 
  • Indo-fijian 
  • iTaukei 
  • Other 
  • Foreign national (Iraqi) 
  • Foreign National (Yameen) 
  • Foreign National (Syria) 
  • Bangladeshi 
  • Chinese 
  • Sri Lankan ( Foreigner) 
  • FOREIGN NATIONAL 

• [Personal detail] Gender
• `Select...`;MaleFemaleOther

• [Personal detail] Disability
• `Select...`;YesNo

• Relevant division
• • Central 
  • East 
  • North 
  • South 
  • West 
  • Maritime islands 
  • western  
  • Iraq 
  • Yameen 
  • Syria 

• Relevant province
• No options found

• [Personal detail] Residential and/or postal address
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• [Personal detail] Phone contact and email address

• [Alleged offender detail] Name

• [Alleged offender detail] Type of respondent
• • State 
  • NGO, please provide more details below 
  • Private, please provide more details below 
  • Legal Aid Commission 
  • Department of Immigration/ UN Refugee Agency in Canberra 
  • Judiciary  
  • Public Rental Board 
  • Bio Security  
  • Mercy Commission 
  • Ministry of Women, Children and Social Protection 
  • Parole Board 
  • Fiji Independent Commission Against Corruption 
  • PRB 
  • Fiji National University 

• [Alleged offender detail] If other, please specify.

• [Alleged offender detail] Residential and/or postal address
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• [Alleged offender detail] Phone contact and email address

• Have you lodged your complaint or sought assistance from any other institution? If yes, please provide details.
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