Office of the State Comptroller and Ombudsman of Israel

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Complaint Form

A complaint can be filed with the Ombudsman in three ways:

1. Complete the following form and press on "send" for electronic submission.

2. Type out the form or use it as a format for a letter and send the same by office fax.

3. Use the form as a format for a letter and send it by electronic mail to the address:ombudsman@mevaker.gov.il

To enable speedy and efficient attention, please complete the details fully and precisely.

* mandatory fields
Number of reference:
Details of the complainant
Title:
If you chose 'Other',complete title:
*First Name:
*Family name:
Identity card number:
If the complainant is a corporation,state its name:

Address
*Street :
*Number:
Neighborhood:
*city:
*Country:
Postcode / Zipcode:

Telephone Numbers
Telephone at work:
Telephone at home:
Cellular telephone:

E-mail
Electronic mail address (if any):

Complaint submitted by an Attorney on behalf of a Client
Name of the Attorney:
Address:
Telephone number:
Electronic mail address:

Details of the Complaint
*Complaint against whom ?
*Subject :
Date of the incident:
Details (in short):

Why is the authority's action unjustified?

What steps have you taken until now to resolve the problem?

Has the matter been decided by a court or tribunal or is it pending before a court or tribunal? Yes No
Relief sought:

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updated on: 6.05.04

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