Office of the Privacy Commissioner - Privacy Act Complaint Form

Please give details and provide copies of relevant documents.

Name of Agency/Organisation:

Date of Complaint:

Is it dealing with your complaint?

This form is to assist you in making a complaint about the handling of your personal information by an organisation or agency under the Privacy Act 1988 (Cth) (the Act).

Please complete this form 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 Act only applies to the information of a living individual.

This form is optional, however, it is important that you include all the information requested as far as it relates to you. If you need more space to complete this form, simply attach additional pages.

If you are unsure about anything, please call the Privacy Hotline during office hours on 1300 363 992 to speak with an Enquries Officer or email your questions to privacy@privacy.gov.au.

Information about our complaint handling process can be found at :
http://www.privacy.gov.au/privacy_rights/complaints/index.html#what_will_happen

About You - the Complainant

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

Name: Mr/Mrs/Miss/Ms/Dr

Mailing Address:

Postcode:

Email:

Mobile No:

Contact phone number during business hours:

( )

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:
		E Mail:
No

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

The Respondent - who you are complaining about

Organisation/Agency:

Individual(s) involved (if known):

Address:

Postcode:

Phone:

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

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?

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

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

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

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 from Baycorp Advantage (Business Information Services) by phoning 1300 762 207, (02) 9464 6000, Dun & Bradstreet on 132333 or the Tasmanian Collection Service on (03) 6223 4555.

Collection Notice

We will use thes information you provide to conciliate and investigate your privacy complaint. Section 43 of the Act authorises the Privacy 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 by this Office, we may need to disclose some information to a court or to a review body like the Adminstrative Appeals Tribunal (AAT).

Office of the Privacy Commissioner • GPO Box 5218, Sydney NSW 2001 • Facsimile +61 2 9284 9666