Complaint Form Step by Step Guide

This guide gives step by step instructions to filling out the Complaint Form. It is important that you fill out the form exactly as instructed. It is a legal document and must be accurate. Please read all the instructions very carefully. Please, ONLY use a pen when completing your complaint form. 2

First Page of the Complaint Form

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Leave this box empty. Legal given name

Legal last name (family name)

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Their legal given name(s) You may file for someone else only if you have a power of attorney, are a parent of a child under age, or are a legal guardian.

Their legal last name (family name)

Their relationship to you. Example: power of attorney, child under age, legal guardian.

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Leave this area empty

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Second Page of the Complaint Form

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Use the official name of the business, organization, association or person you believe discriminated against you. Check a pay stub or T4 for the official name.

Only write one name in this box.

Contact information for the Respondent.

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Fill in one box for each Respondent. Only write one name in each box.

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Third Page of the Complaint Form

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Only choose the boxes that apply to this complaint. If you are unsure about which areas to check, please call our office at 1-888-471-2233 11

I

ONLY choose the ground(s) that apply to this complaint. If you are unsure about which grounds to check, please call our office at 1-888-471-2233

Do not write in any additional information or grounds.

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ONLY choose the box(es) that apply to this complaint. For example, if you believe that you were discriminated against based on your age and sex in the previous section, you would ONLY fill out the Age and Sex boxes.

If you are unsure about any of the grounds, please call our office at 1-888-471-2233. You do not have to fill out all of the boxes; fill only the ones that apply. 13

Fourth Page of the Complaint Form

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This must be a New Brunswick location. Tell when the discrimination started. Use the format Year/Month/Day Example: 2014/07/31 15

If you answer yes, go to section ii.

Reminder: there is a one year time limit to file complaints. Unless you get a time limit extension, you can only complain about what happened in the last year. For help to figure out the one year period, please contact us at 1-888-471-2233

If you answered no, tell when the discrimination stopped. Use the formatYear/Month/Day

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Explain what is happening now. Provide names and dates as often as possible.

Reminder: there is a one year time limit to file complaints. Unless you get a time limit extension, you can only complain about what happened in the last year. For help to figure out the one year period, please contact us at 1-888-471-2233

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Fifth Page of the Complaint Form

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Write your statement to support your complaint. This helps the Commission decide if it can accept your complaint. It is important to clearly describe each incident of discrimination you are saying happened.

Describe how each incident relates to the area(s) (Section C) and ground(s) (Section D) that you checked in the previous sections. Include who did what, and when each incident happened. Provide dates. If you need to add addition pages you may do so. Make sure ALL additional pages are signed, dated and have the page numbers at the bottom. 19

Sixth Page of the Complaint Form

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Explain how you were treated differently from the others. If you were treated the same, explain how it affected you negatively. Provide dates. If you need to add additional pages, you may do so.

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Seventh Page of the Complaint Form

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Be sure to sign and date each of the four sections.

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It is very important that you fill out this section (signature, date, page numbers) on EVERY page of your complaint form.

Your signature. You are the Complainant.

The date that you are completing the Complaint Form. It should be written in the format Year/Month/Day Example: 2014/06/30

Write the page number of the current page in the first blank, and in the second blank write the total number of pages that your Complaint Form includes. For Example- Page 1 of 7 Pages. 24

Complaint Form Checklist  If you added pages to the Complaint Form, make sure these pages are included, signed, and numbered as part of the complaint.  Sign and date the bottom of each page of your complaint form.  Complete the Contact Information Form. Do NOT staple it to your complaint form. Do NOT count this page as a page of your complaint.  Complete the Medical and Personal Information forms. Do NOT staple them to your complaint form. Do NOT count them as pages of your complaint. 25