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IHR Sensitive & PSEA Complaints Form
First Name
Last Name
Gender
-
Male
Female
Date of Birth
Email address
Mobile No
Address
Preferred way to be contacted
-
WhatsApp
Email
Field visit
Do not Contact
Marital Status
-
Single
Married
Widowed
Other
Complaint Type
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Breach of code of conduct
Breach of PSEA policy
Complainant Type
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Beneficiary
Employee
Host Community
IDP
Local Council
Volunteers
Residency Status
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Resident
Displaced
Returnee
Do you have a disability?
-
No, I don't
You
A family member
Type of disability
The Complaint Description
Attachments, if any
I hereby confirm my consent to share data with the relevant party.
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