ANNEX III: COMPLAINT FORM If you are not so authorized, please explain the nature of your relationship with that person: ................................................................................................................................. and detail why you consider it appropriate to bring this complaint on his or her behalf: ................................................................................................................................. II. State concerned/Articles violated Name of the state that is either a party to the Optional Protocol or has made the relevant Declaration: ................................................................................................................................. Articles of the Covenant or Convention alleged to have been violated: ................................................................................................................................. III. Exhaustion of domestic remedies/Application to other international procedures Steps taken by or on behalf of the alleged victims to obtain redress within the state concerned for the alleged violation – detail which procedures have been pursued, including recourse to the courts and other public authorities, which claims you have made, at which times, and with which outcomes: ................................................................................................................................. If you have not exhausted these remedies on the basis that their application would be unduly prolonged, that they would not be effective, that they are not available to you, or for any other reason, please explain your reasons in detail: ................................................................................................................................. Have you submitted the same matter for examination under another procedure of international investigation or settlement (e.g. the Inter-American Commission on Human Rights, the European Court of Human Rights, or the African Commission on Human and Peoples’ Rights)? ................................................................................................................................. If so, detail which procedure(s) have been, or are being, pursued, which claims you have made, at which times, and with which outcomes: ................................................................................................................................. 109