Schedule 4 Reply by respondent

I……………………(name of person questioned) of……………………..…..(address) hereby acknowledge receipt of the questionnaire signed by you and dated…………..which was served on me on……………….(date).

[I agree that the statement in paragraph 1(2) of the questionnaire is an accurate description of what happened.]

[I disagree with the statement in paragraph 1(2) of the questionnaire in that………………….……]

I accept/dispute that my treatment of you was unlawful discrimination [harassment].

[My reasons for so disputing are……………………………………… The reason why you received the treatment accorded to you and the answers to the other questions in paragraph 3 of the questionnaire are……………………]

(Replies to questions in paragraph 4 of the questionnaire.)

[I have deleted (in whole or in part) the paragraph(s) numbered…………………above, since I am unable/unwilling to reply to the relevant questions in the correspondingly numbered paragraph(s) of the questionnaire for the following reasons……………………….]

……………………………………(signature of person questioned)

………………………….(date)