Compensation Application Form

Ombudsperson’s Office for Transitional Justice

Compensation Application Form

    1. Applicant’s Information
    (As in NID Card/Passport)
    2. Date or Time Period of Incident:*
    3. Information of the State Institution(s) or Authoritative Person(s) Accused:
    (Please include information of the state institution(s) or authoritative person(s) at the time of the incident.)
    # Name of Authoritative Person
    / Name of Institution    		 Contact Number
    (If known)    		 Current Address
    (If known, including island & atoll)    		 If currently employed, Name of the Institution and Designation
    (Including island & atoll)    		 Name of the Institution of Employment and Designation at the Time of Incident
    (Including Island & Atoll)
    4. Type of Case
    (Please tick as needed)
    # Type of Case Tick
    Compensation for systematic violation of human rights and fundamental freedoms by a state institution
    Compensation for systematic violation of human rights and fundamental freedoms by a person who was in an authoritative position of power of a state institution
    Compensation for systematic violation of human rights and fundamental freedoms by a person currently in an authoritative position of power of a state institution
    5. Information of the State Institution(s) accused
    # Name of Institution Department/Unit/Office/Centre Atoll/City/Island
    6. Details of the Case:*
    (Please include the facts of the case and any other relevant information, listing each point separately)
    7. Details of Damages Caused:
    (Please submit copies of supporting documents related to the damages)
    8. Total Amount and Details of the Calculation for the Compensation Claimed
    (Please submit copies of supporting documents related to the damages and details of any other requested remedies)
    9. Information of Witnesses, if any
    (Please provide the copy of NID Card/Passport, with their consent)
    # Name Permanent Address
    (Including Atoll & Island)    		 Current Address
    (Including Atoll & Island)     		Contact Number Relevant Point to be Proven:
    10. If known, please provide the location and details of documents, photos, audio and videos that can be used as evidence
    # Location of Evidence
    (Name, Island, Atoll)    		 Details of Evidence
    11. If previously submitted to another institution, details of the relevant institution(s):
    (Please include replies/documents received)
    # Name of Institution
    (Including Atoll & Island)     		Date or Time Period of Submission
    (Please indicate if not known)
    12. Details of any court judgment(s):
    (Please attach a copy of case report. If unavailable, please include case number or date/time-period or attach a copy of case submission form)
    # Name of Court
    (Including Atoll & Island)    		 Case Number (If known) Date or Time Period of Submission
    (Please indicate if not known)
    13. Details of any tribunal decision(s):
    (Please attach a copy of case report. If unavailable, please include case number or date/time-period or attach a copy of case submission)
    # Name of Tribunal Case Number (If known) Date or Time Period of Submission
    (Please indicate if not known)
    14. Details of other documents/video/audio/photos to be submitted with the form:
    (Please enclose the listed items with the form)
    15. Compensation or Remedies Requested:*
    (Please include details)
    16. Declaration and Signature of Applicant:

    I hereby declare that the information in this application is true and complete to the best of my knowledge. I understand that should the information in this application be proven false, Ombudsperson’s Office for Transitional Justice has the authority to take necessary legal action, in addition to nullifying the application and withdraw all decisions made based upon this application.

    Note:

    Please note that incomplete applications and applications without the required documents will not be accepted. In such cases, applicants will be given the chance to resubmit the form along with the required documents. For cases submitted via email or website, applicants will be notified via email to resubmit their applications.

    Documents and Items to be Submitted with the Application
    1. Copy of the NID Card/Passport or Formal Identification Document*

    2. If applicant is a legal entity, copy of the Certificate of Registration

    3. If applicant is a legal entity, board resolution

    4. Copies of the supporting documents for compensation listed in Section 7 of this form*
    5. Copies of the supporting documents for damages listed in Section 8 of this form*
    6. Copies of the NID Cards of witnesses listed in Section 9 of this form (with their consent)
    7. Copies of the replies/documents received from institutions as listed in Section 10 of this form

    8. Copies of case report(s) of courts listed in Section 12 of this form

    9. Copies of case report(s) of tribunals listed in Section 13 of this form

    10. Additional documents/videos/audio/photos, etc. listed in Section 14 of this form*
    Important Information

    1. If there is not sufficient space to include the necessary information under the sections in this form, you may submit an additional document (in the same format) indicating the number of the section(s).

    2. If you would like to submit any additional information not included in this form, you may submit it as an additional document.

    3. Handwritten forms must be filled with a fade-resistant pen, and should be clear and readable.

    4. If preparing a form similar to this form, it should be in size 12 of “Times New Roman” font.

    5. For further inquiries, please contact us via our hotline on 7337486 or via email at complaints@otj.gov.mv

    6. If you require any assistance in filling the forms, please contact us on our hotline number or visit us at our office.

    7. The Word and PDF versions of this form and further details will be available on our website.