Regulation 33(1)
To .................... (name of person to be questioned) of
.................... (address)
1.—(1) I .................... (name of questioner) of ....................E+W+S
....................(address)
consider that you may have discriminated against me [subjected me to harassment] contrary to the Employment Equality (Religion or Belief) Regulations 2003.
(2) (Give date, approximate time and a factual description of the treatment received and of the circumstances leading up to the treatment.)
(3) I consider that this treatment may have been unlawful [because ....................
(complete if you wish to give reasons, otherwise delete)].
2. Do you agree that the statement in paragraph 1(2) above is an accurate description of what happened? If not, in what respect do you disagree or what is your version of what happened?E+W+S
3. Do you accept that your treatment of me was unlawful discrimination [harassment]?E+W+S
If not—
why not,
for what reason did I receive the treatment accorded to me, and
how far did considerations of religion or belief affect your treatment of me?
4. (Any other questions you wish to ask.)E+W+S
5. My address for any reply you may wish to give to the questions raised above is [that set out in paragraph 1(1) above] [the following address ....................E+W+S
....................].
....................(signature of questioner)
....................(date)
N.B.—By virtue of regulation 33 of the Employment Equality (Religion or Belief) Regulations 2003 this questionnaire and any reply are (subject to the provisions of that regulation) admissible in proceedings under the Regulations. A court or tribunal may draw any such inference as is just and equitable from a failure without reasonable excuse to reply within eight weeks of service of this questionnaire, or from an evasive or equivocal reply, including an inference that the person questioned has committed an unlawful act.