Report Discrimination Questionnair

ALL INFORMATION WILL BE KEPT PRIVATE AND CONFIDENTIAL

    Name (required):
    Email (required):
    Mobile No. :
    Date of incident :
    Time of incident :
    Details of incident:
    What happened?
    Where?
    How many witnesses?
    Name of offending person or organisation (if you have obtained it)?
    Do you wish FAIR to assist you with this complaint?