(Section 41)
Date___________
Name of Complainant ____________________________________
Address of Complainant __________________________________
Contact Telephone No.____________________________________
Name of Non-Governmental Organization/member, officer, trustee or director of Non-Governmental Organization against whom the complaint is being made ________________________________________________
Particulars of the complaint*________________________________
________________________________________________
*(Continue on a separate sheet if necessary and attach hereto)
Received by_________________________________________
Name and signature_____________________________________
Date_____________________________________________