2 PRIVACY ACT COMPLAINT FORM DATE 1 YOUR

HEART OF LIFE SPIRITUALITY CENTRE PRIVACY
INFORMATION PRIVACY INDIVIDUAL ACTION PLAN HONG KONG CHINA
PRIMARY SCHOOL PRIVACY NOTICE PLEASE READ THIS NOTICE

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050 PRIVACYREGLEMENT PERSONEELSGEGEVENS SOORT DOCUMENT REGELING INGANGSDATUM 01012011 LAATST
0S PRIVACY SECURITY HIPAA PRIVACY RIGHTS AND OPERATIONS GUIDE

PRIVACY ACT COMPLAINT FORM

2

2 PRIVACY ACT COMPLAINT FORM DATE 1 YOUR


PRIVACY ACT COMPLAINT FORM


Date:__________________

1. Your name and contact details


Name: Mr/Mrs/Ms/


Postal address, and email:



Telephone number/s:



2(a) The name and contact details of the person and/or organisation (“the agency”) about whose actions you are complaining (we will need to tell them of your complaint)


Name:


Postal address:



Telephone number/s:



(b) What is your relationship to that agency (eg employee, client, family member, patient)?





3. Have you already contacted the agency about your complaint?




If your answer is yes, what was the response? Please send us copies of any correspondence that you have had with the agency about the matter.


If your answer is no, please contact the agency first to try to sort the matter out directly. The agency may have a privacy officer who can assist you.



4. What types of action would resolve your complaint?










5. What is the complaint about? (please tick the relevant box or boxes and provide details)


2 PRIVACY ACT COMPLAINT FORM DATE 1 YOUR

  1. That you have asked for access to information about you and that request has been refused;



  1. T2 PRIVACY ACT COMPLAINT FORM DATE 1 YOUR hat you have asked for information about you to be corrected, or have provided a statement of correction to be attached, and that request has been refused;


If you have asked for access to information about yourself or have asked for correction of information about yourself, please send us copies of the request and the response or give clear details of when the request was made.


  1. T2 PRIVACY ACT COMPLAINT FORM DATE 1 YOUR hat information about you was disclosed to someone else (please specify what information was disclosed, when it was disclosed and to whom it was disclosed);




  1. T2 PRIVACY ACT COMPLAINT FORM DATE 1 YOUR hat information about you was used without being checked to see if it was correct;




  1. T2 PRIVACY ACT COMPLAINT FORM DATE 1 YOUR hat information about you was unlawfully or unnecessarily collected (please specify what information was collected, and from whom it was collected);




  1. T2 PRIVACY ACT COMPLAINT FORM DATE 1 YOUR hat information about you was not kept reasonably secure;



  1. O2 PRIVACY ACT COMPLAINT FORM DATE 1 YOUR ther (please specify)




Please send us copies of any documents you have which can show us what happened, or make clear notes of what happened (with dates and other details).



6. Explain how this action or these actions of the agency have caused (or may cause) a negative effect on you (please provide evidence where available)







This information is collected by the Office of the Privacy Commissioner (PO Box 10094, The Terrace, Wellington 6143). It will be used to assist us to investigate your complaint. If you wish to access this information, or correct it, please let us know.

/A234576



2 PRIVACY ACT COMPLAINT FORM DATE 1 YOUR
30TH ANNIVERSARY OF THE OECD PRIVACY GUIDELINES REMARKS BY
8S PRIVACY SECURITY MINIMUM NECESSARY LIMITED DATA SET AND


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