MPCC Complaint Form

A. Complainant's Personal Information

1 Name

Rank (if applicable)

First Name *

First name is required.

Last Name *

Last name is required.

2 Address and Phone Number

Address Type

Personal

Work

Number, Street, Apt *

Street address is required.

City *

City is required.

Province/Territory *

Province is required.

Postal Code *

Postal code is required.

Mailing address (if different than above)

Home Telephone

Work Telephone

Cellphone

Email Address *

Please enter a valid email address.

Preferred contact method

Home Phone

Work Phone

Cellphone

3 Language(s)

Official language of choice *

English

French

B. Declarations, Consent and Signature

1 I declare that I am withdrawing my complaint because: *

Please provide your reasons for withdrawing.

2 I understand that by withdrawing my complaint, I will not be able to reactivate or submit a new complaint in relation to the same matter at any time in the future *

Yes, I understand

Please confirm you understand.

3 I declare that I am withdrawing this complaint voluntarily *

Yes, I understand

Please confirm the withdrawal is voluntary.

4 I consent to the Military Police Complaints Commission of Canada processing my request for withdrawal of my complaint and understand that official correspondence confirming the withdrawal will be sent to me, the office of the Canadian Forces Provost Marshal, and any of the persons I complained about *

Yes, I understand

Please confirm your consent.

By submitting this form, I certify that the information I have given is true to the best of my knowledge, and that I have read and understood the Privacy Notice.

Signature

Signature of complainant*

Signature of complainant is required.

Date of complaint*

Date of complaint is required.

Once completed, you may submit the form electronically by clicking on the “Submit Form” button. Supporting documents cannot be attached to this submission. You will receive a copy of your complaint by email from the MPCC. If you have any additional documents to provide, you can do so upon receipt of the confirmation by responding to the email from the Commission.