Title *

Mr. Mrs. Ms.

Full name *

National ID number *

Address *

Phone number *

Email / LINE ID

Complaint *

Noise problem
Dust problem
Odour problem
The problem of volatile organic compounds (VOCs) in the atmosphere.
The problem is with the foul-smelling water.
Solid waste problem
Other problems

The period during which the complainant experienced the problem. *

Complaint/Grievance Details *

Does it have any impact on health? *

Yes   No

What are the health effects?