COMMUNITY COMPLAINTS AND FEEDBACK
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EN
KIN
Fill this form to Report Poor Service
PUBLIC
CALL
SMS
SOCIAL MEDIA
E-MAIL
Personal Information:
Do you want to report Anonymously?
*
Do want to specify your personal information?
No
Yes
Name
Enter your name as it is written on you National ID
Phone
Enter your valid Phone number
Gender
*
Male
Female
Year of Birth
*
Select the year you were born
Service Details
Category
*
Select category of poor service related
VERY GOOD
GOOD
POOR
VERY POOR
Did you experience Corruption ?
Did someone request corruption from you?
Yes
No
Suspect Name
Add the Suspect name if you know him/her
Suspect Phone
Add the Suspect phone number if you know him/her
Occurrence Date
*
Add the date on which you received the service
Summary
*
Add the summary of how services was, (max characters 1000)
1000/1000
Recommendation
Add the Recommendation of how services was, (max characters 1000)
1000/1000
Attachment
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