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1. Complainant Information (उजुरीकर्ताको विवरण)
Full Name (पूरा नाम): Optional / वैकल्पिक
Phone/Mobile Number (फोन/मोबाइल नम्बर):
Email Address (इमेल ठेगाना): Optional / वैकल्पिक
Sex (लिङ्ग):
Male (पुरुष)
Female (महिला)
Other (अन्य)
Prefer not to say (भन्न नचाहने)
Place/Project/Office (स्थान/परियोजना/कार्यालय):
2. Complaint Details (गुनासोको विवरण)
Who is the complaint about? (गुनासो कसको विरुद्ध हो / को संलग्न छन्?)
What happened? (के भएको थियो? कृपया संक्षिप्त विवरण दिनुहोस्।)
When did it happen? (घटना कहिले वा कुन अवधिमा भएको थियो?)
How did you learn about the incident? (घटनाबारे तपाईंलाई कसरी थाहा भयो?)
Witnesses, if any (साक्षी भए नाम/सम्पर्क): (Optional)
3. Support and Expected Action (सहयोग तथा अपेक्षित कारबाही)
What action or resolution do you expect? (कस्तो समाधान वा कारबाहीको अपेक्षा गर्नुहुन्छ?)
Are you connected with NSET? (के तपाईं NSET सँग प्रत्यक्ष वा अप्रत्यक्ष रूपमा आबद्ध हुनुहुन्छ?)
Staff/Employee (कर्मचारी)
Volunteer/Consultant (स्वयंसेवक/परामर्शदाता)
Other (अन्य)
Project/Program Participant (परियोजना/कार्यक्रम सहभागी)
Partner/Stakeholder (साझेदार/सरोकारवाला)
Other (अन्य):
No (छैन)
4. Additional Information (थप विवरण)
Please provide any other information relevant to your complaint. (Optional) गुनासोसँग सम्बन्धित अन्य जानकारी भए उल्लेख गर्नुहोस्।
5. Consent (मञ्जुरीनामा)
By submitting this complaint, I understand and agree that NSET will process my complaint in accordance with its Complaint Handling Policy and Procedures.यो गुनासो पेश गरेर, NSET को गुनासो व्यवस्थापन नीति तथा प्रक्रियाअनुसार मेरो गुनासोको प्रक्रिया अगाडि बढाउन म सहमत छु।
Yes, I agree. / हो, म सहमत छु।
Date
Note: You may submit this complaint confidentially. NSET will handle the information in accordance with its applicable policies and procedures.
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