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Individual Complaint Form (Complaints only related to foreign employment)
Whom are you complaining for?If for others, what is your relation with the victim?
Full Name:
Permanent Address:
Email:Mobile/ Telephone No:
Marital status:No. of family members
SexDate of birth
Citizenship No:Passport Number:
Place of Issue:Place of Issue:
Full Name nearest kin
Contract no. of the nearest kin
Nearest kin and relationship:
Nearest Contact Person in Destination:
If yes, please mention the date when sufferer return to Nepal:
Grievance Details
Process Incorporated :
Destination Country :
Full Name Recruitment Agencies :
Address of Recruitment Agencies :
Full Name Employer in Destination Country:
Address of Employer in Destination Country:
Amount Invested (in figures):
Details of Incident
Date of Incident:
Place of incident:
Please give the details of incident and its effects (please add papers upon requirement).
Have you filed any complaint about the incident in any agency, police force, court, government bodies, NGOs, etc.? Yes No If yes, please name the organization and process/progress made till date.
Please list the evidences related to the case.
1. Contract Letter

2. Insurance Coverage

3. Labour Approval LetterI, undersigned, certify to the best of my knowledge, that the details written in this form are true.