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I am making a complaint under the Human Rights Commission of Malaysia Act 1999 for assessment by the Human Rights Commission of Malaysia (the Commission). I understand that the personal information provided in this complaint form is collected under the authority of the Act. Such information is to be used and/or disclosed for the purpose of the processing of this human rights complaint or as otherwise required by law. I consent to the release to the Commission of all information and documents concerning me that the Commission considers necessary to deal with my complaint. I also authorize the Commission to have such information examined by any person it retains to provide advice and assistance in dealing with my complaint.

I declare that the information I provided is true to the best of my knowledge or belief.

(Desclimer : The Commission is not responsible for any loss or damage whatsoever arising out of or in connection with the use of this system.)