Police Matters – Transparency Institute Guyana Inc.

1. Name *

First

Last

2. Address: Lot Number *

Address: Street Name

Address: Village/Ward

Address: City

Address: Region

3. Landline:

Cellphone:

WhatsApp Number:

4. Would you like us to publish your name in any action we take or would you like us to keep it confidential:

5. Nature of Matter

If you chose 'Other' state the nature of your matter here:

6. Name of Police station to which reported: *

7. Month when matter was reported: *

8. Date of Last action from police: *

9. Why are you not satisfied?

If you chose 'Other' state why you are not satisfied here:

10. Have you taken this matter to anybody higher than the local police? If so, to who?

If you chose 'Other Person' please state that person here:

11. Has this other officer taken any other action?

12. What action has he taken? (State below)

13. Would you like TIGI to take the following steps in order?

1. Include your matter in a list to be published without mentioning your name?
2. Include your matter in a list to be published mentioning your name after ___ weeks?
3 Write the officials on your behalf and keep listing the matter until settled?

If you selected 2. from above, state the number of weeks below: