Grievance Redress Mechanism Form

REGISTRATION OF GRIEVANCE

We are pleased to present our Grievance Redress Mechanism which uses this complaint form through which individuals and communities affected by the project being implemented may register their concerns.

Name: *

Address:

E-mail Address: *

Contact No:

National ID No:

Optional

NIS No:

Optional

Gender: *

Location of Project Site:

Optional

As per the ESMF of the Project’s Grievance Redressal, I register my grievance as detailed:

Details of Grievance

(a) Outline reasons why and how you are affected by the Project. *

(b) If land or other properties are being affected e.g. (agriculture), include copies of relevant documentations you have to support your claim. List documents: attach copies

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Undertaking: I hereby certify that statements made in my Grievance and documentation enclosed are true and complete to the best of my knowledge. If at any time any part of the Grievance or the documentation is found to be false, I will be liable for any legal action that the Government of St. Vincent and the Grenadines may deem necessary.

Date:

e-Signature:

Phone

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