Sample Complaints Form

Below is an outline of the basic information required in any communication submitted to the CEDAW Committee. As this is only meant to serve as a guide, such information need not be limited to the contents or format proposed below. If further information or an alternative format better facilitates, for example, the explanation of the violation(s), the status of the individual(s) concerned, the demonstration of multiple forms of discrimination or the justification for interim measures, authors of communications are free to employ alternative routes in setting out the basis of the communication.

1. Information on the author(s) of the communication:

• Family name
• First name
• Date and place of birth
• Nationality/citizenship
• Passport/identity card number (if available)
• Sex
• Marital status/children
• Profession
• Ethnic background, religious affiliation, social group (if relevant)
• Present address
• Mailing address for confidential correspondence (if different from present address)
• Fax/telephone/email
• Indicate whether you are submitting the communication as:
• Alleged victim(s). If there is a group of individuals alleged to be victims, provide basic information about each individual.
• On behalf of the alleged victim(s). Provide evidence showing the consent of the victim(s), or reasons that justify submitting the communication without such consent.

2. Information concerning the alleged victim(s) (if other than the author)

• Family name
• First name
• Date and place of birth
• Nationality/citizenship
• Passport/identity card number (if available)
• Sex
• Marital status/children
• Profession
• Ethnic background, religious affiliation, social group (if relevant)
• Present address
• Mailing address for confidential correspondence (if other than present address)
• Fax/telephone/e-mail

3. Information on the State party concerned

• Name of the State party (country)

4. Nature of the alleged violation(s)

Provide detailed information to substantiate your claim, including:

• Description of alleged violation(s) and alleged perpetrator(s)
• Date(s)
• Place(s)
• Provisions of the Convention on the Elimination of All Forms of Discrimination against Women that were allegedly violated. If the communication refers to more than one provision, describe each issue separately.

5. Steps taken to exhaust domestic remedies

Describe the action taken to exhaust domestic remedies; for example, attempts to obtain legal, administrative, legislative, policy or programme remedies, including:

• Type(s) of remedy sought
• Date(s)
• Place(s)
• Who initiated the action.
• Which authority or body was addressed
• Name of court hearing the case (if any)

If domestic remedies have not been exhausted, explain why.

Please note: Enclose copies of all relevant documentation.

6. Other international procedures

Has the same matter already been examined or is it being examined under another procedure of international investigation or settlement? If yes, explain:

• Type of procedure(s)
• Date(s)
• Place(s)
• Results (if any)

Please note: Enclose copies of all relevant documentation.

7. Date and signature

• Date/place
• Signature of author(s) and/or victim(s)

8. List of documents attached (do not send originals, only copies)

Source: “Model form for submission of communications to the Committee on the elimination of discrimination against women under the Optional Protocol of the Convention” <http://www.un.org/womenwatch/daw/cedaw/protocol/modelform-E.PDF>