You can make a privacy complaint by using our new online Privacy Complaint form (this form requires Adobe Reader 9.3 or later). For technical reasons these forms are hosted for us by the Australian Government on the Australian Business Account portal. When you complete and submit a form your information is not accessible to anyone other than ourselves. Simply select the"Use a blank form and keep your own records" option and then complete the form. If you do not have access to Adobe you can instead use this downloadable Word version or just print this page and fill it out (adding additional pages if necessary).

Our privacy complaint form helps you make a complaint about the handling of your personal information by an organisation or agency under the Privacy Act 1988.

You can make a complaint if you are complaining about a breach of your privacy or you are complaining about a breach of somebody else’s privacy on their behalf, and you have their consent to do so. Remember, the Privacy Act only applies to the information of a living individual. If you are unsure about anything, please call the OAIC Enquiries Line during office hours on 1300 363 992 to speak with an Enquiries Officer or email your questions to enquiries@oaic.gov.au.

Using a form is optional, however, it is important that you include all the information requested as far as it relates to you. Our preference is for you to use the online Privacy Complaint form if at all possible.

More information about our complaint handling process.

 About You - the Complainant

Your details - please only provide the contact details that you are happy for our staff to use to contact you.

For administrative purposes, please advise if you have lodged a complaint or enquiry with our office before?

Yes	Please provide your previous reference number: Eg: C0001 or E0001
	If unknown please provide the mailing address you used in your previous complaint or enquiry
No

Do you have a representative with whom you would like us to discuss your complaint? For example a lawyer?

Yes	Name of Representative:
	Mailing Address:
	Phone:
	Email:
No

Please advise our office as soon as possible if any of your contact details change.

The Respondent - who you are complaining about

I am complaining about

If you are complaining about more than one Respondent, please provide the details on an additional page.

Have you complained to the Respondent?

The Privacy Commissioner requires that, as an initial step, you raise your complaint in writing with the Respondent and allow it 30 days to respond. Have you done this?

Yes

No

If Yes, what was its response, if any? Please attach a copy (not the original) of your complaint to the respondent and any letter of reply you have received.

Your Complaint

How do you believe your privacy has been breached?

Please describe the events which you allege were an interference with your privacy (attach additional sheets if necessary). We need to know:

• What information the Respondent holds about you
• What happened
• Where it happened
• When it happened (include dates)
• Who did it (include names of individuals involved)
• How and when you found out about it
• Any other relevant details

How would you like to see your complaint resolved? What action would you like the Respondent to take to resolve your complaint?

Have you taken this complaint to another agency or organisation?

Yes	Please give details and provide copies of relevant documents.
	Name of Agency/Organisation:
	Date of Complaint:
	Is it dealing with your complaint?	Yes	No
No

Documents

Please give us copies (not the original) of any documents that may help us to investigate your complaint (for example, any correspondence or records of conversations you have had with the Respondent, including their letter of reply).

If your complaint involves your credit information file, please attach a copy of it. These may be available by phoning Veda Advantage on 1300 762 207 and Dun and Bradstreet on 1300 734 806 and, if resident in Tasmania, the Tasmanian Collection Service on (03) 6213 5555.

Please sign and date this form.

Collection Notice

We will use the information you provide to conciliate and investigate your privacy complaint. Section 43 of the Privacy Act authorises the Office of the Australian Information Commissioner to collect information for investigations. We will usually disclose the information you give us to the Respondent and, if necessary, to others who have information relevant to your complaint. In case of a challenge to a decision we make, we may need to disclose some information to a court or to a review body like the Adminstrative Appeals Tribunal.

Office of the Australian Information Commissioner - GPO Box 5218, Sydney NSW 2001 - Facsimile +61 2 9284 9666