Grievance T3

NOTE: A comment may be submitted anonymously, or non-disclousure of the applicant's data to third parties without the applicant's consent may be demanded.

Applicants first name and surname I wish to submit a complaint anonymouslyI demand that my personal details be not disclosed without my consent

CONTACT DETAILS - Please indicate hoe the applicant sholud be contacted (by e-mail, by phone, or by post).

E-mail By phone By post (please enter the correspondence address

Preferred language for communication.

PolishEnglishOther Other (please specify?

Description of the subject of the case / compilant

The subject of the case / compilant; when did the case occur?; provide the location relating to the case / compilant; list the persons involved in the case; what are the effects of the ensuing situation?

Date of the incident / occurrence of the subject of the complaint / emergence of the case.

One-time incident / complaintOngoing (a currently existing problem)Happened more than once Indicate hoe many times:

According to the applicant,

...what measures would provide solution to the problem?

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