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Complaint Details
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A. PARTICULARS OF THE COMPLAINANT/REPRESENTATIVE
Indicate whether you are filing as self or on behalf of other individual(s)
As myself
On behalf of other individual(s)
Proof of authorization
First Name
Surname
Other
Complainant’s National Identification Card Number/Passport
Telephone No/Mobile No where complainant can easily be reached
Clear
Postal Address
Physical address or location (for statistical purpose only)
NAIROBI
MOMBASA
BARINGO
BOMET
BUNGOMA
BUSIA
ELGEYO
EMBU
GARISSA
HOMABAY
ISIOLO
KAJIADO
KAKAMEGA
KERICHO
KIAMBU
KILIFI
KIRINYAGA
KISII
KISUMU
KITUI
KWALE
LAIKIPIA
LAMU
MACHAKOS
MAKUENI
MANDERA
MARSABIT
MERU
MIGORI
MURANGA
NAIROBI
NAKURU
NANDI
NAROK
NYAMIRA
NYANDARUA
NYERI
SAMBURU
SIAYA
TAITA
TANA
THARAKA
TRANSZOIA
TURKANA
UASIN
VIHIGA
WAJIR
WEST
Complainant Email Address
Preferred Mode of Communication
Email
Telephone
Select the type of document to upload
None
ID
Passport
Upload ID Front
(PDF, JPG, PNG, JPEG)
Upload ID Back
(PDF, JPG, PNG, JPEG)
Upload Passport Front Page
(PDF, JPG, PNG, JPEG)
B. PARTICULARS OF THE RESPONDENT
Name of respondent
Contact details of the respondent (Individual or Institutional):
C. PARTICULARS OF THE COMPLAINT
Date of occurrence of the alleged infringement
Describe your complaint
Any actual or potential harm or any urgency to be taken note of:
The name (s) of any persons that can provide further information relevant to the complaint, if any;
D. REMEDY SOUGHT
State in your view what redress/relief you are anticipating:
Which other steps have you already taken in relation to the complaint; if any
Particulars of any person or institution that has previously made attempts to resolve the matter:
In the event that the Respondent is contacted, do you wish to remain anonymous?
Yes
No
If yes, please explain why
Do you wish to provide any evidence or supporting documents?
I confirm that the information provided here is accurate
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Withdraw/Discontinue Complaint
Withdrawal Form
Complaint No.
State reason for withdrawal/discontinuation of complaint
I confirm that the information provided here is accurate
Withdraw Complaint
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