COMPLAINANT:
Please confirm your relationship with the Complainant. i.e. are you a friend, colleague, solicitor, accountant, etc.; and on the second and following lines, explain the reason you are requesting the Facilitation or Discussion on behalf of the Complainant.
Please explain the reason you are requesting the Facilitation and not the Complainant.
Do you give permission for your name and relationship with the Complainant to be included on all reports as the Complainant’s representative?
If you have a relationship with the Respondent, please include these details.
COMPLAINANTS RELATIONSHIP WITH THE RESPONDENT:
If the Complainant has more than one relationship with the Respondent i.e. student and client; please select other and enter the details in the following field.
RESPONDENT’s NAME and CONTACT DETAILS:
THIRD PARTY(IES) and/or WITNESS(ES):
Please provide the outline of all communications between the Complainant, and/or the Third Party/Parties and/or the Witnesses.
REASON FOR YOUR REQUEST FOR FACILITATION:
Please enter the relevant clause or clauses reference separating each reference on a different line.
Please enter ‘NONE’ where there is no applicable code.
REQUEST FOR FACILITATION DETAILS:
Please enter the details in the fields below, explaining the details of this Request for Facilitation.
In the fields below:
- explain the event, the actions, all communication, and relevant information.
- at this point in the process, the Ombudsman Service is looking for the specifics in relation to how this Request for Facilitation came about.
The Ombudsman Service may request additional information, to support the details you provide here and in the following fields.
Please provide the background to the relationship between the Complainant and the Respondent.
Please provide the details of each event that led to you raising this Request for Facilitation.
Please provide the details of each action you took before raising this Request for Facilitation.
Please provide the details of each action that the Respondent took that led to you raising this Request for Facilitation .
Where there is more than one Respondent, it is important that you start each action with the Respondent's name.
Please provide the details of each action that the Third Party/Parties took that led to you raising this Request for Facilitation.
Where there is more than one Third Party/Parties, it is important that you start each action with the Third Party/Parties name.
Please provide the details of each action that the Witness/es took that led to you raising this Request for Facilitation.
Where there is more than one Witness/es, it is important that you start each action with the Witness/es name.
Please enter ‘NONE’ if there is no further relevant information.
ADDITIONAL INFORMATION:
If you wish to forward your supporting information by email, please email ombudsman-service@ircmcic.org and include your name (as entered above) in the subject line.
PREFERRED OUTCOME:
ADDITIONAL INFORMATION