* 1. Complaint Type
* 2. Legal First Name
* 3. Legal Last Name
4. Social Name
* 5. Birth date
* 6. Telephone number
* 7. Personal E-mail
* 8. Document type
* 9. Document Number
* 10. Sex according to legal document
* 11. Address
* 12. Area
* 14. Country of Birth
* 15. Country where violation occurred
* 16. Does Someone know about your HIV diagnosis?
17. If your answer is YES, do you give us authorization to contact them??
18. Name of support person that knows your diagnosis
19. Telephone number of support person that knows your diagnosis
20. Email of support person that knows your diagnosis
* 21. Details of violation
* 22. Where did the violation occur?
* 23. When\ndid the incident occur?
24. Do you Know the name of the person who aggravated you?
25. What is the name of the institution or place where incident occurred?
26. Please provide us the address of the institution or place where incident occurred?
27. Please provide us the area/department or service station of the person´s who aggravates you
28. Have you presented this complaint to another authority?
29. Mention where
30. Mention any other important details