Privacy Complaint Form 1 Personal Details2 Representative3 Complaint Details4 Submit The National Education and Care Services Privacy Commissioner (NECS Privacy Commissioner) can investigate complaints from individuals about the Australian Children’s Education and Care Quality Authority (ACECQA) and State and Territory Education and Care Services Regulatory Authorities under the Commonwealth Privacy Act 1988. You can complain to the Commissioner if you believe ACECQA or a State or Territory Regulatory Authority has interfered with your privacy by breaching an Australian Privacy Principle in relation to your personal information. Personal information is any information that is about an individual and can reasonably identify that individual. The NECS Privacy Commissioner encourages you to raise your complaint with ACECQA or the State or Territory Regulatory first and give them an opportunity to address your concerns before applying to the Commissioner. Complaints to the NECS Privacy Commissioner must be submitted in writing. If you have trouble completing this form please send an email to firstname.lastname@example.org or call the office on (03) 9654 1077 About You - The ComplainantNote: The NECS Privacy Commissioner cannot investigate complaints about a breach of an individual’s privacy if the complaint is made anonymously. Title*Full Name*PhoneMobileEmail* Postal Address*City*Postcode*State*Please selectAustralian Capital TerritoryNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern AustraliaPreferred contact method*EmailPhonePostMobileOther Do you have someone who you would like to represent you in your complaint?*YesNoRepresentative’s DetailsWhat is your representative’s relationship to you? (eg Lawyer)*Representative’s organisation name (if any)Title*Full Name*Phone*Mobile*Email* Postal Address*City*State*New South WalesVictoriaQueenslandWestern AustraliaSouth AustraliaTasmaniaAustralian Capital TerritoryNorthern TerritoryPreferred contact method*EmailPhonePostMobileOther Please provide details of your complaint.About the Agency – the RespondentPlease provide details of the agency you are complaining about (ie ACECQA or a State or Territory Education and Care Services Regulatory Authority)* Name of Agency*Have you complained to the Respondent?*I have complained to the agency about my privacy issue and given them 30 days to reply.I have not complained to the agency about my privacy issueNote: The NECS Privacy Commissioner will only investigate complaints where the complainant has not first raised the complaint with the agency in question in exceptional circumstances. If you have not raised your complaint with the agency please explain why it is not appropriate for you to do so.*Agency Reference NumberIf the agency has given you a reference number relevant to your complaint please tell us this number.If you know the names of officers in the agency you have contacted please provide them.Details of your ComplaintPlease provide a summary of your complaint. You may attach further documentation if you wish.*ResolutionWhat action or result would you like from the NECS Privacy Commissioner?*Supporting InformationPlease attach any supporting documentation including, if applicable, details of any information provided to you by the agency with respect to your complaint. If you are the nominated representative lodging the complaint for someone else, please attach any documents which indicate you are authorised to act for that person. Supporting documentation Drop files here or Confirm and submit.Full Name*I confirm that all the information contained in this complaint form is true and correct.* Confirmed Would you like to receive a copy of your complaint? Yes Email Address* CommentsThis field is for validation purposes and should be left unchanged.