Form Fill | Prime Laravel Form Builder

Project Name:

Country:

Project Location (Province, City, etc.):

Please explain the type of harm you believe the World Bank-supported project has caused or is likely to cause you or your community.

Social

Yes

Environmental

Yes

Othe

Yes

Comments:

Have you raised your complaint through the project-level grievance mechanism?

Yes

What action was taken by the project-level grievance mechanism to resolve the complaint?

How do you wish to see your complaint resolved?

Signature: You may print the form and sign it. Alternatively, you may click in the box below and add a photo of your signature if you prefer

Date of complaint: Please attach supporting documents, if available.