File a Consumer Complaint Form-14 – Consumer Complaint form Form-14-Consumer-Complaint-form-1.pdf Pay TV case – Consumer Complaint Form 4.7.23-Pay-TV-case-Consumer-Complaint-Form.pdf FORM INSTRUCTIONSThe COMESA Competition Commission welcomes consumer complaints from natural and legal persons regarding any perceived violation(s) of Part 5 of the COMESA Competition Regulations.Page 1 of 4I. DETAILS OF COMPLAINANT (natural or legal person submitting this Complaint):Anonymous SubmissionIf the Complainant prefers to remain anonymous, please check this box (by ticking this box, the Commission will not disclose your personal identification details to any other party).Full Names of Complainant*Physical AddressPostal AddressCountry & CityName of Contact Person in case of a company*Email address*Phone Number 1Phone Number 2If you are not the affected person, kindly state how you became aware of the conduct that is the subject of this complaint.Is this Complaint being filed jointly with other natural and/or legal person(s)?*YesNoIf yes, provide their name(s), contact details and other relevant information below.NextII. RESPONDENT PARTY (natural or legal person against whom this Complaint is made)Full NamesAddress/LocationPhoneFaxEmail addressOther Contact Details of the RespondentIf there is more than one Respondent Party, kindly provide the names, address/location and contact details in a separate sheet of all the Respondent Parties on a paper to be attached to this complaint.When did the issue/ Incident Occur?BackNextIII. COMPLAINT DETAILSPlease provide a clear description of the complaint*Attach all relevant documents pertaining to the complaintcontracts, warranty, receipts, invoices, delivery notes and any other documents.Have you ever raised this complaint to the Respondent Party?YesNoIf yes, when?What was the response?Indicate, to the extent possible, the relative market positions of the undertakings concerned by the complaintHave you raised the complaint with the National Consumer Protection Agency?YesNoHave you raised the complaint with other Regulator (s) in your country?YesNoHave you raised the complaint with National Courts?YesNoOther, Please specifyWhat was the response?How would you like your complaint resolved?Please note that your complaint may be passed on to another institution or body (within COMESA), if the Commission finds that it does not have jurisdiction.BackNextV. DECLARATIONDeclaration*I declare that the information given/supplied by me to the COMESA Competition Commission in this Complaint and all supporting documents attached hereto is accurate to the best of my knowledgePlease enable JavaScript to submit this form.BackSendThis field should be left blank
