Complaint Form

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THE CIVIL AVIATION (PROCEDURES FOR COMPLAINTS HANDLING) RULES, 2008

Made under r. 9(3)

COMPLAINT FORM

For Authority’s Use Only

Complaint No…..of……..

____________________________________vs._______________________________
Complainant Respondent

 USE CAPITAL LETTERS TO PRINT


 USE A SEPARATE SHEET IF NECESSARY

A: PARTICULARS
EITHER
Physical Person:

Name of Complainant (surname, first name):


__________________________________________________________Sex:_______________
Address: _____________________________________________________________________
_____________________________________________________________________________
Profession: ____________________________________________________________________
_____________________________________________________________________________
Nationality: ___________________________________________________________________
Date of birth: _________________________________________________________

OR

Legal Person:

Name of Complainant: __________________________________________________________


_____________________________________________________________________________
Status (e.g. limited liability company/body corporate/association etc)_______________________
_____________________________________________________________________________
Physical Address: ______________________________________________________________
_____________________________________________________________________________
Who is representing: _____________________________________________________________
_____________________________________________________________________________
Name of the person signing the complaint and his status: ________________________________
_____________________________________________________________________________
Name of the respondent: ________________________________________________________
_____________________________________________________________________________
Address: _____________________________________________________________________
Occupation: __________________________________________________________________

B: NATURE/FACTS OF THE COMPLAINT


(State the complete description of the complaint precisely and concisely; include copies of all
relevant documents)
______________________________________________________________________________________
______________________________________________________________________________________
___________________________________________________________
If known, the reference to specific laws, regulation, concession contracts, licences, codes or norms
which were supposedly infringed.
______________________________________________________________________________________
______________________________________________________________________________________
___________________________________________________________

C: EVIDENCE THAT THE COMPLAINANT HAS SUBMITTED THE COMPLAINT TO THE


REGULATED SUPPLIER AND THAT AVENUES WHICH COULD SOLVE THE PROBLEM
WERE EXHAUSTED ACCORDING TO THE REGULATED SUPPLIER’S PROCEDURES
______________________________________________________________________________________
______________________________________________________________________________________
___________________________________________________________

D: DESCRIPTION OF THE RESPONSE OR REMEDY WHICH THE REGULATED


SUPPLIER IN QUESTION HAS MADE OR OFFERED
______________________________________________________________________________________
______________________________________________________________________________________
___________________________________________________________

E: DESCRIPTION OF THE REMEDY OR REMEDIES DESIRED


______________________________________________________________________________________
______________________________________________________________________________________
___________________________________________________________

F: I hereby declare that all the facts and information given in the application are correct
to the best of my knowledge.

Presented for filing this _____________ day of _______________________ year ___________

________________________________
SIGNATURE OF THE COMPLAINT(S)

For Registrar’s Use Only

Date Received:__________________ File No.________________________________

Date Resolved:_________________________________________________________

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