Form

Receipt of a Complaint from the Ethiopian Media Authority Media Service

Name of complainant

The location of the complainant

Region / City

Zone Sub City

District

Phone

Do you want to make a suggestion or a complaint?

Which media outlet is your complaint?

What is your complaint about the media outlet?

When did the event that led to your complaint take place in the media?

Did you submit this complaint to the media?

Yes

No, I did not submit

If so, how did they respond?

Has the case been taken to court?

Yes

No, not taken

Are you affected by the issue that led to your complaint?

Owner

Representative

If you are a representative, submit your power of attorney and additional evidence to ------------------- Date at our institution office number ----------------- Present.

Date