Complaint form - to complain about a public body

Please note that fields marked * are mandatory.

A: Your details

Your name in full:*

Address and postcode:*

Your email:*

Daytime contact number:

Mobile number:

The person who experienced the problem should normally fill in this form. If you are filling this in on behalf of someone else, please fill in section B.

B: Making a complaint on behalf of someone else: Their details

Their name in full:

Address and postcode:

What is your relationship to them?

Why are you making a complaint on their behalf?

C: About your complaint

Name of the public body you are complaining about:*

What do you think this body did wrong, or failed to do?*

How have you suffered personally from this?*

What do you think they should do to put things right?

When did you first become aware of the problem?*

Have you already complained to the body concerned? If so, please give brief details of how and when you did so.*

If it is more than 12 months since you became first aware of the problem, please give the reason why you have not complained to the Ombudsman before now.

Do you have any documents to support your complaint? Please tick appropriate box below:

Yes No

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