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FORM I PROFORMA FOR FILING OF COMPLAINTS OF SEXUAL HARASSMENT

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Specify further.

4.

Was the first incident reported? To whom?

When? What action, if any was taken?

5.

Approximate date(s), time(s) and location(s) of

incident(s), starting from the most recent.

Additional details of the complaint may be recorded here:

Complaint filed by

Signature:

Date:

Name:

Place:

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