New Complaint Form

Complaint Form

SECTION A1 : THE COMPLAINT

Name*

Address:*

Contact Number (Home):

Contact Number (Office):*

Contact Number (Mobile):*

Email Address:*

Are you representing an organization (e.g. company, association, partnership, or society) in making this complaint?:*

Yes No

SECTION A2 : ORGANIZATION DETAILS

Name of the organization you represent:*

Company Registration No.:*

Address:*

Contact Number (Home):

Contact Number (Office):*

Contact Number (Mobile):*

Fax Number:

Email Address:*

Website:

SECTION B : WHO IS THE COMPLAINT AGAINST

Name of the organization:*

Address:*

Contact Number (Home):

Contact Number (Office):*

Contact Number (Mobile):

Fax Number:

Email Address:

Website:

Please describe the principle commercial activities of this organization:*

SECTION C : RELATIONSHIP

What is your relation with the organization against whom the complaint is made?:*

Specify:

SECTION D : DESCRIPTION OF ANTI-COMPETITIVE ACTIVITY

Nature of anti-competitive activity complained against:*

Please Specify:

What are the goods or services to which the anti-competitive activity relates?:*

Please describe the anti-competitive activity you are complaining about and explain how it affects you or the organization you are representing:*

When did this anti-competitive activity start?:*

Is this anti-competitive activity still continuing?:*

Yes No

When did this anti-competitive activity end?:

SECTION E : DETAILS OF OTHER PARTIES WHO MAY BE ABLE TO PROVIDE FURTHER INFORMATION REGARDING THE COMPLAINT

Details of Other Parties:

Index	Name of Party	Contact No.	Address	Email Address
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SECTION F : COMPLAINT FILE ATTACHMENT

Please submit letter of authorization proving the representative's authority to act on behalf of the organization (if relevant):
(please upload in .jpg, .jpeg, .pdf and .png format and size must not exceed 20MB)

Index	Filename
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Add Letter of Authorization:

Please attach all evidence supporting your complaint and submit relevant documents (e.g. agreements, minutes of meetings, business documents, circulars, correspondence, note of telephone conversation etc.):
(please upload in .docx, .xlsx, .jpg, .jpeg, .png, .bmp, .gif, .mp4, .mp3, .mpeg and .pdf format and size must not exceed 20MB)

Index	Filename
{{index + 1}}

Add Evidence File:

Information submitted in this form will be restricted and treated accordingly, as per Section 70 on Preservation of Secrecy of the Competition Act.
Pursuant to Section 70(4) of the Act, clearly identify any confidential information and explain why this information should be treated as confidential. Please refer to CCBD Guidelines on Applying for Confidential Treatment for more information and guidance.

SECTION G : DECLARATION

I declare that the information I have submitted in the Complaint Form is true and correct to the best of my knowledge and belief.

I understand that it is an offence to provide false and misleading information to the CCBD.

Information provided in this form will be treated restricted and treated accordingly, as per Section 70 on Preservation of Secrecy of the Competition Act.