N DA POLIC

UGA E

PROTE RVE
CT & SE

UGANDA POLICE FORCE

Ref. No...................................

Date: ......................................

COMPLAINT/S AGAINST A POLICE OFFICER [POLICE FORM 105]

PART I: INTRODUCTION

This form is for lodging complaint/s against a police officer on cases of violation of human rights
and unprofessional conduct under Section 70 of the Police Act 303, which provides for complaints
by the public against police officers. A person is entitled, without prejudice to any other legal means
of redress available to him or her, to make a written complaint as to – (a) ant instance of bribery,
corruption, oppression or intimidation by a police officer; (b) any neglect or non performance of his
or her duties by a police officer; (c) any other misconduct by a police officer.

PART II: COMPLAINANT PARTICULARS

1. Name: ....................................................................................................................................

Age: .......................................................................................................................................

2. Gender: Male Female

3. Place of Residence [Village, Sub County, District, Plot No.]

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4. Telephone: ............................................................................................................................

5. Email:....................................................................................................................................

PART III: DETAILS ABOUT THE COMPLAINT

(a) Who is involved [Fill in the Victim's Names, Age and Gender]?

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(b) What happened?

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(c) When did this take place? [Date/Time/Year]

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(d) Where did it happen?

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(e) Was there any damage/injury? If Yes, describe

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(f) Were there any witnesses present? [No or Yes]

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(g) Have you been examined by a Medical Officer? [No or Yes]

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(h) Have you reported this incident to any police station? If yes provide the reference given

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PART IV: POLICE OFFICER/S AGAINST WHOM A COMPLAINT IS MADE

(a) Name/s: .................................................................................................................................

(b) Rank/Description: .................................................................................................................

(c) Other means of identification (Colour of Uniform, Name tag, budge number, any unique
physical features, etc)

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(d) Details of the Police Unit where the Police Officer works or is attached if known.

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