Customer Complaint Form

Required fields are marked with an asterisk (*).

Use this form to lodge a complaint about any of Council's services

Contact Details

Firstname

Surname

Mobile Enter your number without spaces

Address line 1

Address line 2

Suburb

State

Postcode

Complaints Form

Witness First Name (if applicable)

Witness Surname (if applicable)

Witness Address (if applicable)

Witness Phone Number (if applicable) Preferable phone number to be contacted on

Details of Complaint * In your summary, if applicable, please include date, time, place, people involved and any background information that could be useful

Would you like to be contacted regarding the outcome of your complaint? *

Has the complaint been raised with Council before? If yes, please provide any documentation regarding your previous contact

As a result of making this complaint, is there any outcome you would like? *

If Yes, please provide details:

Customer Complaint Form

Online Forms

Clare & Gilbert Valleys Council