MILITARY OMBUD COMPLAINT FORM
COMPLAINT IN TERMS OF SECTION 6(2) MILITARY OMBUD ACT 4 OF 2012
(Regulation 3)
Undertaking
I apply to the Military Ombud to investigate and consider my complaint. All relevant documentation is attached
1. I
declare that my complaint does not relate to:
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The manner in which a military judge performs his or her functions in his or her capacity as a judge;
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A matter that is pending before a military or civilian court; or
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A matter on which a decision has been taken by a military or civilian court.
2. I understand the Military Ombud may refuse to investigate a complaint if:
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An investigation may undermine channels of command or constitute insubordination in the Defence Force;
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A complaint is not lodged within the prescribed time-frame.
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A member has not first used the mechanism available under the Individual Grievances Regulations, 2010, unless the complaint relates to problems inherent in the system which bring about an adverse result to the complainant;
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A complaint was not lodged within the prescribed timeframe and condonation was not granted; or
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A complaint was referred for arbitration, conciliation, mediation or negotiation to another competent tribunal or forum.
3. I understand and agree that by submitting this complaint:
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The complaint and all information contained therein will be treated as confidential by the Military Ombud.
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A finding of the Military Ombud does not affect my legal rights or privileges; and
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Should I not be satisfied with the decision of the Military Ombud, I may apply to the High Court for review against that decision in terms of section 13 of the Military Ombud Act 4 of 2012.
In terms of the Protection of Personal Information Act (POPIA), the Military Ombud will collect and process your personal information only for purposes related to handling this complaint.
(Regulation 3)
Origin Information
Please Note:
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Kindly complete the form in a legible manner and complete all relevant sections.
Please note that the fields marked with an asterisk (*) are compulsory.
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Where the contact person is not the complainant, please provide the relevant person’s correct contact details.
If the contact person is acting on behalf of the complainant, a Power of Attorney must accompany this form.
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If you have previously referred your complaint for investigation, arbitration, conciliation, mediation or negotiation to another competent tribunal, forum or institution, kindly furnish the relevant details and applicable reference number.
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Be as comprehensive as possible and provide as much factual detail as possible when completing this form.
Ensure that you answer the following questions: Who, When, How, Where and What happened thereafter.
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Attach all supporting documentation and evidence, which may include copies of photographs,
copies of documentation, sworn statements of witnesses, copies of official documents given to
you by the Department of Defence, or any other information that may assist the Military Ombud
in conducting an investigation.
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The Declaration and consent section of this form must be completed to authorise the Military
Ombud to obtain copies of records and to access any information that relates to this complaint.
In which province in South Africa did the complaint originate?
Where did you learn about the Office of the Military Ombud?
Declaration & Consent
The consent granted to the Military Ombud in this paragraph authorises the Military Ombud to obtain copies of any records, to access any information which relates to this complaint and to contact any person or entity for the purposes of obtaining or verifying such information and/or documentation.
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I declare that to the best of my knowledge, the information provided in the complaint form is true and correct in every respect;
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I confirm that I am complaining in my personal capacity / representative capacity;
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I hereby consent to the release, to the Military Ombud, of copies of all documentation and/or information that in any way relates to this complaint;
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I further consent to and authorise the Military Ombud to contact any person or entity for purposes of obtaining or verifying such information and/or documentation.
Digital signatures are not required.
Submission date will be recorded automatically when you submit.
Reference:
Your IP address will be recorded as:
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