COMPLAINT FORM Dear Complainant, Our commitment is to ensure performance of judicial and prosecutorial functions in the Republic of Kosovo in the most decent and lawful manner. Please fill out the entire form accurately, trying to follow the instructions below. Bear in mind that the only purpose of this form is to assist you in completing and submitting your complaint. INSTRUCTIONS 1. Write in hand, type or print legibly in ink. 2. Fill all the information required in the respective field. This form contains optional fields you may fill out but it is not mandatory. Pay attention to the fields requiring information about the subject of complaint! Bear in mind that the mandate of the Office of Disciplinary Council (ODC) is to conduct investigations regarding possible misconduct by judges or prosecutors but not any other staff assigned within the judicial/prosecutorial system of the Republic of Kosovo. 3. State the facts concerning the alleged judge's/prosecutor’s misconduct very accurately and precisely. This will help the ODC to identify whether your complaint provides a reasonable basis to believe that the alleged misconduct may have occurred. Please note, the ODC does not have any authority to review decisions of judges and prosecutors. This can only be done within the court/prosecutorial system through regular or extraordinary remedies. If you seek to change the outcome of your case, discuss this with an attorney without delay. 4. Provide relevant information of witnesses and other persons who have knowledge on occurrence. 5. Attach all available documents that in your opinion prove the statement of facts made within the complaint. 6. Date and sign the application. The ODC will strictly observe all its obligations as to confidentiality. 7. Send your complaint along with all its attachments to the ODC postal address: Office of Disciplinary Prosecutor Str. Luan Haradinaj Former OSCE building, floor 2 10000 Pristina, Kosovo or e-mail: zef.prendrecaj@rks-gov.net NOTE: Complaints sent to a wrong address may not be processed. 8. Complaints and attachments will not be returned. I. (PERSONAL) INFORMATION of COMPLAINANT Last Name, First Name/ Name of Legal Entity: Name of Complainant's Representative (Attorney/Manager/Other) (Optional) Citizenship/State of company registration (Optional) Occupation/Scope of business (Optional) Permanent Address Address for correspondence Email Address Telephone Numbers Home: Work/Office: Mobile: II. SUBJECT OF COMPLAINT First and Last name of the Judge/Prosecutor concerned: Position/Capacity Please, tick off the box next to the position occupied by the person addressed in your complaint! Judge Basic Court Judge Prosecutor Court of Appeal Judge Supreme Court Judge Prosecutor in Special Prosecution Office (Local) Prosecutor in Basic Prosecution Office Prosecutor in Appellate Prosecution Office Prosecutor in State Prosecution Office Other Court/Prosecution Office, Location OPTIONAL III. If your complaint arises out of a court case, please fill in the relevant information in the right field below. If not, proceed directly to field IV INFORMATION ABOUT THE CASE CONCERNED Case number Type of case Civil Criminal Family Labour Please, tick off the box in front of the right type! Complainant's involvement in the above specified case Please, tick off the right box! Plaintiff/Petitioner Defendant/Respondent Attorney Current stage of proceedings Pending Final decision Have you complained about the same Yes Registration number of the facts before? Please, tick off the right box and provide the requested information! complaint number: and/or ODC Case …………………………. IV. What is your complaint? Please give details! Witness Other Appeal No Other V. INFORMATION ON WITNESSES (OR OTHERS WHO HAVE KNOWLEDGE OF THE EVENTS DESCRIBED) Name Contact details Other relevant information Name Contact details Other relevant information Name Contact details Other relevant information 1. 2. 3. VI. OPTIONAL LIST OF ATTACHMENTS 1. 2. 3. ............................... VII. SPECIAL REQUIREMENTS, CONFIDENTIALITY; CONTACT DETAILS; OTHER The information provided is considered confidential and will be used solely by the ODC for investigation purposes. It will be disclosed to the concerned judge/prosecutor to the extent necessary as to ensure the safeguard of the rights and to the bodies competent for disciplinary issues in Kosovo, which on their behalf are bound to keep the confidentiality. Please note, If you have any special requirements as to confidentiality; the disclosure of your name, contact details; other, please state them here. This will help the ODC to process the complaint in the most appropriate manner. I personally/on behalf of the Complainant certify that the allegations and statements of circumstances set forth above are true and correct to the best of my knowledge, information, and belief and are made of my own free will. ___________________________ Place and Date ________________________ Signature of Complainant/Representative of Complainant