Create - FTC Market Surveillance Software

Part 1: DETAILS OF COMPLAINANT

Please fill in the form below to lodge a Complaint

If you prefers to remain anonymous, please tick this box proceed to part 2.

Complaninant Name(s)

Website

Address

Email Address

Phone Number

Are you representing an enterprise (e.g. company association, partnership or society) in making this complaint?

Supplier Name

Other relevant details

PART 2: DETAILS OF RESPONDENT

Brief Description of principal activity of the enterprise: (e.g. manufacturer, distributor, retailer)

If there are other enterprises involved in the alleged conduct/agreement, please tick the box and provide the names and contact information in a below box.

PART 3: RELATIONSHIP WITH RESPONDENT

PART 4: DESCRIPTION OF THE ANTI-COMPETITIVE CONDUCT/ AGREEMENT

Nature of the Anti-competitive Activity

Abuse of Dominant Position
Restrictive Horizontal Practices.
Corporate Immunity (Pleas tick this box if you wish to apply for Corporate Immunity).
Restrictive Vertical Practices
Mergers effected without applying to the Fair Trading Commission

Please provide a comprehensive statement on how this anti-competitive conduct/agreement is affecting you or the enterprise you are representing: (Indicate when the anti-competitive conduct/agreement started and if it is still on- going)

Please list all the evidence supporting your complaint and attach all the relevant documents to this complaint: (e.g. agreements, minutes of meetings, business documents, circulars, correspondence) Please identify any part of the information that should be treated as confidential.(Single PDF file)

Details of other parties who may be able to provide further information regarding your complaint

PART 5: MARKET INFORMATION

Set out your views on your possible competitor(s) in the market and provide their market share (or an approximate)

Tick this box if you have taken any other action prior to lodging the complaint and state the outcome

A person who gives to the Commission or an officer of the Commission any information which he or she knows to be false or misleading commits an offence and is liable on conviction to a fine of level 4 on the standard scale or to imprisonment for a term not exceeding 2 years or to both such fine and imprisonment.

“I, the undersigned warrant that the information given in this complaint is true, accurate and complete to the best of my knowledge, that the attached copies of the documents are unabridged, that all estimates are identified as such and submitted to the best of my knowledge of the facts of the case, and where an opinion is stated in good faith”

Competition Complaint Form

Part 1: DETAILS OF COMPLAINANT

PART 2: DETAILS OF RESPONDENT

PART 3: RELATIONSHIP WITH RESPONDENT

PART 4: DESCRIPTION OF THE ANTI-COMPETITIVE CONDUCT/ AGREEMENT

PART 5: MARKET INFORMATION