Lutheran World Federation Department for World Service

Complaints Submision Form

This form should be completed by the person wishing to lodge a complaint or documented by a third party. All information must be held securely and confidentiality must be maintained at all times.

1 Start 2 Complaint 3 Incident Description 4 Proof/Witnesses 5 Response 6 Complete

A: General data

Personal information

1. Name of the person lodging the complaint

We encourage you to give your contact details. Anonymous complaints may be difficult or even impossible to investigate. Investigators may need to contact you for clarification or additional information. Contact information will be handled confidentially and it will be shared only with those who need to know it when investigating the complaint.

1.1. Sex *

Male

Female

Contact information

2. Address

3. Telephone

3.1. Email

Incident Information

4. Name of the person you wish to lodge a complaint against (if known):

5. Date and time of incident *

Day, Month, Year – Hour:Minutes (provide the exact time of the incident if known). Example: Friday, October 16, 2020 - 11:06

6. Place of incident

Please provide the place of the incident. Complaints of incidents without an exact location may be difficult or even impossible to investigate. Information will be handled confidentially and it will be shared only with those who need to know it when investigating the complaint.

7. Date and time of reporting *

Day, Month, Year – Hour:Minutes Example: Friday, October 16, 2020 - 11:06

Leave this field blank

Lutheran World Federation Department for World Service

Complaints Submision Form

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