Date:		09/09/2010
Choose a category that describes your problem in general:	*	--- Choose --- Termination of Employment Non payment of wages Employer denies to grand a specific benefit Hours of employment or work Other
Are terms and conditions of employment covered by a collective agreement:	*	--- Choose --- Yes No
Are you a member of a Trade Union:		--- Choose --- Yes No
If yes, please mention the Trade Union's name:		--- Choose --- SEK PEO DEOK Other
Trade Union's Name:
Details of Employer:
Name of Employer:	*
Address:	*
Telophone:	*
Contact Person:
E-mail:
Please describe your complaint, or problem, giving full details (i.e. dates, money involved, years of service in the company, names of involved persons etc):

Fields with * are mandatory.