File a Banking and Credit Complaint

Page X of X Z questions on this page

Required fields are marked with a red asterisk.

  • If you do not know the answer, type “Unknown”.
  • If the field does not apply to you, type “NA”.
You must complete the entire form to submit it. This form cannot be saved for later.

Disclaimer

The Louisiana Commission on Human Rights can only investigate discrimination that happened within the past year (365 days).

The Louisiana state law R.S. 51:2254 and the Louisiana state law R.S. 51:2255 say it is illegal to deny, or charge more for, someone getting banking and credit services because of

  • race,
  • creed,
  • color,
  • religion,
  • disabilty,
  • or national origin.

Complete this form only if you believe you have been discriminated against because of one of these reasons. Please take your time to answer all questions completely and accurately.

  • This form has a total of # questions and # are required.
  • Additional questions can become required based on your answers.

The Louisiana Commission on Human Rights can only investigate discrimination that happened within the past year (365 days). When we get the form, we will review it to determine if we can get involved. If you have difficulty understanding these instructions or have questions, contact our office at (225) 342-6969, and a member of our staff will assist you.

Required Evidence

  • Keep in mind the burden of proof is on you. Your evidence is important and helps determine the outcome of the complaint.

After you fill out the Banking and Credit complaint form, we will need information from other people and some extra documents to investigate your complaint. Our form asks questions about the people and documents that might help prove that any mistreatment you experienced. To be most useful to your complaint, the people you identify generally should have direct knowledge of how you were treated and/or information about how your treatment compared to that of other people. This form asks for the basic information that we need to decide whether or not we can investigate your public accommodations-related problem.

You can download a paper version of the Banking and Credit Complaint form if you prefer to fill it out by hand.

Check If You Qualify

Home

Personal Information

Alternate Contact Information

If we cannot reach you directly, who can we contact to help us reach you?

Organization

What financial institution do you believe has discriminated against you?

Discrimination

What is the reason (basis) for your claim of discrimination? What happened to you that you believe was discriminatory?

Check all that apply.
For example, if you checked “Sex” please tell us whether you are male or female.
Include date(s) and describe the action, name and title of the person(s) responsible.

Disability Discrimination

Provide answers for this section if you have a disability or a disability relates to the discrimination claim.

Check all that apply.
Does this disability prevent or limit you from doing anything such as lifting, sleeping, breathing, walking, caring for yourself, working, etc.? If so, how does this disability affect you?
Please provide the full name of the person.

Similarly Situated

Use the section below to describe who was in the same or similar situation as you. How were they treated? For example, who else requested service from the organization? Tell us the reason they said they suffered discrimination, if you know it, and it relates to what you suffered For example, if your complaint is about race, tell us the race of each person.

Provide all details of the person who was in the same situation as you.

Provide all details of the person who was in the same situation as you.

Provide all details of the person who was in the same situation as you.

Witnesses

Tell us about any witnesses, if any, to the discrimination.

Provide all details of the witness.

Provide all details of the witness.

Provide all details of the witness.

Previously Filed Complaints or Assistance

Tell us about any other complaints you’ve filed, whether with us or another agency, or about any assistance you’ve received about this complaint.

Signature and Date

I declare under penalty of perjury, under the State of Louisiana, I certify that all statement contained in this Intake Form and all accompanying documents are true and correct to the best of my knowledge and belief.

By typing your full name in the field above, you are electronically signing the information provided by your responses.
PRIVACY ACT STATEMENT:

This form is covered by the Privacy Act of 1974: Public Law 93-579. Authority for requesting personal data and the uses thereof are:

  1. FORM NUMBER/TITLE/DATE. EEOC/FEPA Intake Questionnaire (10/2006).
  2. AUTHORITY. 42 U.S.C. § 2000e-5(b), 29 U.S.C. § 211, 29 U.S.C. § 626. 42 U.S.C. 12117(a)
  3. PRINCIPAL PURPOSE. The purpose of this questionnaire is to solicit information in an acceptable form consistent with statutory requirements to enable the Commission to act on matters within its jurisdiction. When this form constitutes the only timely written statement of allegations of employment discrimination, the Commission will, consistent with 29 CFR 1601.12(b) and 29 CFR 1626.8(b), consider it to be a sufficient charge of discrimination under the relevant statute(s).
  4. ROUTINE USES. Information provided on this form will be used by Commission employees to determine the existence of facts relevant to a decision as to whether the Commission has jurisdiction over allegations of employment discrimination and to provide such charge filing counseling as is appropriate. Information provided on this form may be disclosed to other State, local and federal agencies as may be appropriate or necessary to carrying out the Commission’s functions. Information may also be disclosed to respondents in connection with litigation.
  5. WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY AND EFFECT ON INDIVIDUAL FOR NOT PROVIDING INFORMATION. The providing of this information is voluntary but the failure to do so may hamper the Commission’s investigation of a charge of discrimination. It is not mandatory that this form be used to provide the requested information.

Complainant’s Consent for Investigatory Use of Personal Information.

  1. I understand that I am not required to give personal information to the LCHR; however, my complaint may be closed if I refuse to supply information needed to investigate my complaint;
  2. I understand that it is my duty to update the personal information I supply and failure to do so may result in my complaint being closed;
  3. I understand that I may receive a copy of any personal information I submit, if I request it; and
  4. I understand that the information provided by me may have to be released under the Public Records Request.

Based on the foregoing, I hereby give my consent to LCHR to process my complaint.

By typing your full name in the field above, you are electronically signing and acknowledging that you agree to the information above.