Issue Number as seen Above
Where is the Issue? —Please choose an option—HospitalStreetCommunitySchoolOthers
Whats the Other Issue?
Whats Wrong at the Hospital? —Please choose an option—No medicineNo doctors / nurseRude StaffNot cleanOthers
Name of Hospital / Clinic
Hospital / Clinic Location
Whats Wrong in the Streets? —Please choose an option—Garbage not collectedStreet lights not workingBad roadNot cleanOthers
Name of Street
Street Location
Whats Wrong in the Community? —Please choose an option—Unclean waterUnsafe electrical wiringsBad roadBad drainageOthers
Name of Community
Community Location
Whats Wrong at the School? —Please choose an option—No desksNo teachersUnclean environmentNo books for Pupils/StudentsOthers
Name of School
School Location
Your Gender * —Please choose an option—MaleFemalePrefer not to Say
Your Phone Number *
Your Age *
Do you want to Attach photos/videos?
Should we hide your Identity? —Please choose an option—YesNo
Note: Before reporting take a screenshot or memorise the Issue number on top. Keep it safe you can use it to track response to your issue, re-report it or give us feedback if the issue has been addressed before we take our actions.
Please leave this field empty.
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