e-Soumissions Compensation claim Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 10If your business has suffered from anti-competitive practices, you can use this form to seek redress. This electronic form allows you to file a compensation claim, offering a secure and structured way to present your case and attach the relevant evidence.I accept the privacy policy of the WAEMU Competition Directorate *YesBy ticking this box, I confirm that I fully agree with the privacy policy of the WAEMU Competition Directorate.NextINSTRUCTIONSThis form should be completed as fully as possible and submitted to the registry of the WAEMU Competition Directorate. Please attach any relevant documents or information in support of your complaint. The information provided in this form is kept confidential as far as possible to enable the WAEMU Competition Directorate to examine your complaint. However, the WAEMU Competition Directorate may disclose this information where necessary to facilitate its investigation. The WAEMU Competition Directorate will contact the complainant if it considers it necessary to disclose this information. However, for the avoidance of doubt, you are entitled to identify the information you consider confidential by submitting a confidentiality request together with this complaint.1. APPLICANT'S CONTACT DETAILSFull name of the applicant or authorised representative *Name and address of the contact person *WebsiteTelephoneEmail address *Description of the industry/sector * Visual Code If this application is submitted jointly with other natural and/or legal persons, please identify them and provide the full contact details of the other applicants. * Visual Code Legal mandate Click or drag files to this area to upload. You can upload up to 99 files. Where this form is completed by an authorised representative, please state the nature of your relationship with the beneficiary and whether you are legally authorised to represent them. (Attach a copy of the legal mandate where applicable)PreviousNext2. CONTACT DETAILS OF THE RESPONDENT(S)Full name of the respondent(s) *Full company name *Address/locationTelephoneEmail addressOther contact details of the respondent(s)WebsiteNature and scope of activities * Visual Code PreviousNext3. DETAILS OF THE ALLEGED INFRINGEMENTGive details of the alleged infringement investigated by the WAEMU Competition Directorate. State the products or services affected by the infringements and explain, where applicable, the business relationships concerning these products or services. * Visual Code PreviousNext4. WAEMU DECISIONProvide all available details of the WAEMU decision on the anti-competitive activity, including any penalties imposed by WAEMU. Visual Code PreviousNext5. IMPACT OF THE INFRINGEMENTPlease explain why and to what extent the infringement has affected your competitive position or that of the person or company you represent. Provide as much concrete evidence as possible * Visual Code PreviousNext6. EVIDENCE OF THE HARM SUFFEREDExplain and provide evidence of the harm you have suffered as a result of anti-competitive conduct. Please provide concrete evidence Visual Code Evidence of the harm suffered Click or drag files to this area to upload. You can upload up to 99 files. PreviousNext7. PROCEEDINGS BEFORE REGIONAL/NATIONAL COMPETITION AUTHORITIES OR COURTSPlease state whether you have approached another regional or national competition authority about the same alleged infringement or a closely related alleged infringement, and/or whether you have brought legal proceedings before a regional or national court. If so, please give details of the authority contacted and of the arguments you put to that authority or court. * Visual Code PreviousNext8. SWORN STATEMENTI declare that the information contained in this form and all supporting documents I have attached are accurate and are provided to the WAEMU Competition Directorate in good faith.Name (in capitals) *Position *Date *PreviousNextUpdating preview…This is a preview of your submission. It has not been submitted yet! Please take a moment to check your information. You can also go back to make changes.PreviousConfirm and submit