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AN INDEPENDENT PUBLIC FORUM
for resolving complaints on the media
Make A Complaint Form
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Date (dd-mm-yyy):
*
Offended Party Name:
*
First
Last
Mobile Number:
*
Email:
*
Address:
*
ID#:
DP#:
Passport#:
Date of Incident
*
Time of Incident
*
Media Source:
*
Television
Radio
Newspaper
Name of Media Company:
*
Detailed Report
*
Report Taken By:
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