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Complaint Form

01. Details of the complainer

Name :*    Address :*
Telephone :*

02. Against which organization is the complaint made?

Ministry of Agrarian Services and Wildlife Department of Agrarian Development
Department of Wildlife Conservation Ceylon Fertilizer Company Limited
Colombo Commercial Fertilizer Company Limited National Fertilizer Secretariat

03. Give the following information related to the complaint:

District :
Divisional Secretariat Division :
Agrarian Services Division :
Grama Niladhari Division :
Village / Street :

04. What is the complaint about?

A financial fraud A fertilizer fraud An un authorized reclamation of paddy land
Against an officer Misuse of public property Other incident

05. Against whom are you making the complaint?

A public officer   An association of farmers  Other

06. Whether evidence is available to prove your allegations?

Yes   No

07. If evidence is available,in what medium can they be presented?

Written Oral Audio Visual medium

08. Give the following information regarding other persons, if any, from whom information related to your complaint can be obtained?

Name : Address :
Telephone :
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All complaints will be treated with complete confidentiality.