Privacy Complaint

Instructions:

This form is designed to assist you to submit a privacy complaint about how the City is collecting, using or disclosing your personal information under the Freedom of Information and Protection of Privacy Act (FIPPA).

Privacy Notice: The personal information on this form is collected by the City of Prince George for the purpose of assisting to resolve your privacy complaint, under the authority of section(s) 26(c) and (d) of the Freedom of Information and Protection of Privacy Act. If you have any questions about the collection of information, please contact the Privacy Officer at 1100 Patricia Boulevard, Prince George, BC, by telephone 250-561-7600 or 311, or email privacy.office@princegeorge.ca.

Full Name

Phone

Mailing Address

City/Town

Province

Postal Code

Are you submitting this complaint on behalf of someone else?

Yes

Supporting Documents

If you checked “on behalf of another individual”, please attach supporting documentation proving you have the authority or consent of that individual to act on their behalf.

Maximum 3 files.
64 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Which department/division does your complaint concern?

Have you tried contacting anyone at the City to resolve your complaint?

Yes

Please list their names

Complaints

Unauthorized collection of your personal information

Unauthorized use of your personal information

Unauthorized disclosure of your personal information

Inadequate security of your personal information

Refusal to correct or annotate records containing your personal information

Other

Summarize your request for review or complaint

Please indicate any file or reference number if applicable

Signature

Legal Name

Date

Agreement

I agree to and acknowledge all the terms of this application