Online complaint form

COMPLAINANT INFORMATION

MR. MRS. MS.
FAMILY NAME:
GIVEN NAME:
MAILING ADDRESS:
CITY:
PROVINCE:	BC AB SK MB ON QC NB NS PE NF NT
POSTAL CODE:
FAX:
HOME TELEPHONE:
WORK TELEPHONE:
CELL PHONE:
OTHER TELEPHONE:
E-MAIL ADDRESS:
PREFERRED LANGUAGE OF CORRESPONDENCE:	ENGLISH FRENCH
IF APPLICABLE, NAME AND ADDRESS OF REPRESENTATIVE, LEGAL OR OTHER, FOR THE PURPOSE OF THIS COMPLAINT:
PLEASE NOTIFY THE COMMISSION IF YOUR ADDRESS OR PHONE NUMBER CHANGE PRIOR TO THE RESOLUTION OF YOUR COMPLAINT.
CIRCUMSTANCES OF COMPLAINT (PLEASE COMPLETE AS MUCH AS POSSIBLE)
DATE OF INCIDENT:
TIME OF INCIDENT:
PLACE OF INCIDENT (PROVINCE & CITY):
DID YOU SIGN A FORMAL COMPLAINT ABOUT THIS WITH THE RCMP?	Yes No
IF YES, WHEN AND WHERE DID YOU SIGN THE COMPLAINT?
DID YOU SIGN AN AGREEMENT THAT RESOLVED THIS COMPLAINT INFORMALLY?	Yes No
PLEASE DESCRIBE ANY INJURIES SUFFERED:
WERE PHOTOS TAKEN OF THE INJURIES?	Yes No
IF YES, WHO TOOK THE PHOTOS?
DID YOU RECEIVE MEDICAL TREATMENT FOR YOUR INJURIES?	Yes No
IF YES, WHAT IS THE NAME OF THE DOCTOR AND HOSPITAL?
DO YOU HAVE ANY OTHER EVIDENCE THAT SUPPORTS YOUR COMPLAINT?	Yes No
IF YES, PLEASE LIST EVIDENCE:
I WISH TO COMPLAIN ABOUT THE CONDUCT OF THE FOLLOWING RCMP MEMBER(S) (IF KNOWN):
1. NAME, RANK AND REGIMENTAL NUMBER:	DETACHMENT:
2. NAME, RANK AND REGIMENTAL NUMBER:	DETACHMENT:
3. NAME, RANK AND REGIMENTAL NUMBER:	DETACHMENT:
4. NAME, RANK AND REGIMENTAL NUMBER:	DETACHMENT:
5. NAME, RANK AND REGIMENTAL NUMBER:	DETACHMENT:
WITNESS(ES) (INCLUDING RCMP MEMBERS NOT COMPLAINED ABOUT)
1. FAMILY NAME:
GIVEN NAME:	TELEPHONE:
ADDRESS:
RELATION TO COMPLAINANT:
2. FAMILY NAME:
GIVEN NAME:	TELEPHONE:
ADDRESS:
RELATION TO COMPLAINANT:
3. FAMILY NAME:
GIVEN NAME:	TELEPHONE:
ADDRESS:
RELATION TO COMPLAINANT:
DETAILS OF COMPLAINT PLEASE DESCRIBE THE INCIDENT AS COMPLETELY AS POSSIBLE. ATTACH ADDITIONAL PAGES, IF NECESSARY.
PLEASE NOTE: THIS COMPLAINT FORM ALONG WITH ALL OTHER NECESSARY DOCUMENTATION MAY BE FORWARDED TO THE RCMP FOR INVESTIGATION PURSUANT TO SUBSECTION 45.35(3) OF THE RCMP ACT. ACCORDINGLY, AN RCMP PUBLIC COMPLAINT INVESTIGATOR MAY CONTACT YOU TO ASK THAT YOU PROVIDE A STATEMENT.
OR you can send the complaint form by fax or by mail