Complaint Title: Mr Mrs Miss Ms Dr First Name: Surname: Date of Birth: Gender: Male Female Address: Postcode: Daytime tel no.: Mobile tel. no.: E-mail Address: Security Verfication: Enter security code: Complaint Details Name and Address of legal representative: Please indicate is you have any special requirements and provide details if applicable (E.G. an interpreter): Please provide details of your complaint against police (please include location, date and time of incident): Can you please identify the officer(s) against whom you are making this complaint (a service number, shoulder number, name or station where based would be helpful): Please confirm whether you sustained any injuries as a result of your interaction with police and if you were medically examined: Did anyone witness your interaction with police? If so please provide names and contact details: What is your allegation of misconduct against police in relation to your complaint?: Please confirm if you were arrested by police and what station you were taken to if applicable: Please indicate if you are being prosecuted for any offences arising from this incident: Please confirm what outcome you hope to achieve by making this complaint: