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New Eden Claims Departament
Olide VI - Moon 10 - CONCORD Bureau

HURT FEELINGS REPORT
For use of this form, see ยง2086 under Section 102F of the Space Traffic Act
PART I - GENERAL INFORMATION
SUPERIOR:
PRINCIPAL PURPOSE:

147-21E CES/12A Departament of Traffic Regulations (DTR)
Please use this form if you wish to make a complaint of alleged misconduct against of a subject.

CLAIM REFERENCE:

70335810317A
PART II - ADMINISTRATIVE DATA
2. AGE:

1. WHINER'S FULL NAME:

male[

3. FACTION/BLOODLINE:

4. SEX:

5. DATE OF REPORT:

6. INSURANCE NUMBER:

]

female[

]

I don't know[

]

PART III - INCIDENT DETAILS
7. DATE AND TIME FEELINGS WERE HURT:
8. LOCATION OF HURTFUL INCIDENT:
9. NAME OF A PILOT RESPONSIBLE FOR YOUR FEELINGS HURTFULNESS:
10. PLEASE SELECT THE NATURE OF THE INCIDENT:

(mark all that apply)

wrecks salvage[ ] loot thievery[ ] mission objectives joink[ ]
ship destroy[ ] dishonoured ransom[ ] insult[ ]
contract scam[
suicide gank[

]

assault[

]

other harassment:

]

...................................

PART IV - INCIDENT CAUSES
11. HOW MUCH DID YOU SUFFER DUE TO INCIDENT?
12. IS THAT A PERNAMENT FEELING DAMAGE?
13. DID YOU REQUIRE A MEDICAL TREATMENT?
14. DID YOU NEED A MOMMY'S HUG?
15. DID YOU REQUIRE A TISSUE FOR TEARS?

quite a bit[

] a lot[ ] I cried[ ] I raged[ ] I had depressive disorder[ ]
yes[ ] no[ ]
I don't know[ ]
yes[ ] no[ ]
maybe[ ]
yes (normal hug)[ ] yes (big bear hug)[ ] no[ ]
yes[ ] no[ ] multiple[ ] (amount .........)

PART IV - REASON FOR FILING THIS REPORT
(mark all that apply)

[
[
[
[
[
[

] I demand justice.
] I feel offended.
] I'm a crybaby.
] My feelings are sensitive.
] I want my mommy/teddy.
] I'm a little girl.

[
[
[
[
[
[

] CCP has rejected my petition.
] I want my money back.
] I am a whimp.
] My real life is miseralble, I'm ugly and the game is all I have.
] I want someone to solve my problems.
] All above and more.

PART V - NARRATIVE
(Tell us in your own sissy words how your feelings were hurt.)

PART VI - AUTHENTICATION
16. PRINTED NAME OF THE WHINER:

17. SIGNATURE:

18. PRINTED NAME OF THE GRIEFER:

19. SIGNATURE:

New Eden Claims Departament, takes hurt feelings seriously. If you don't have someone who can give you a hug and make things all better, please let us know and we will
promptly dispatch a "hugger" to you ASAP. In the event we are unable to find a "hugger" we will notify the fire departament and request that they send fire personel to your
location. If you are in need of supplemental support, upon written request, we will make every reasonable effort to provide you with a blankey, a binky and/or a bottle of milk if
you so desire.


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