Complaint withdrawal form - CHRC Make a Complaint

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Information about your complaint

Name of the person withdrawing complaint

First name

Last name

Email address

Confirm email

Complaint File Number (if there is more than one file, please list all files)

Name of the Respondent

First name

Last name

Organization Name

I am withdrawing my complaint because

I have settled/resolved my complaint with the Respondent(s)

I do not want to proceed any further with my complaint

Consents

I understand that by withdrawing my complaint(s), I will not be able to reactivate it/them or submit a new complaint on the same matters at any time in the future.

Declaration and Signature

If you are filing your form electronically, your digital signature represents your legal signature.

I declare that to the best of my knowledge, all of the information I have provided with this form is truthful, complete and accurate.

Date

Print Name