Download the PDF version of this form You must have JavaScript enabled to use this form. Your Information Last name First name Middle initial(s) Preferred name Address Unit City Province - None -AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince EdwardQuebecSaskatchewanYukon Postal Code If you consent to the IPC contacting you by phone including leaving a voicemail message, please provide your phone number. If you wish to communicate with the IPC by email, please provide your email address (required) ? Are you: Filing a privacy complaint about your own personal information The substitute decision-maker (such as a parent or guardian) for someone who is filing a privacy complaint about their personal information Substitute decision-maker information If you are a substitute decision-maker (such as a parent or guardian) making a complaint on behalf of someone else, please describe your role and explain your relationship. It may be necessary to provide documentation to prove you are authorized to act for the individual. Please attach this documentation if you have it at the end of this form. Skip this section if you are not a substitute decision-maker. Representative Information Representative is a: Lawyer Other person Last name First name Middle initial(s) Preferred name Address Unit City Province - None -AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Phone number Email address Skip this section if you do not have a representative.You may represent yourself in a complaint to the IPC, or have someone else (such as a lawyer or another person) represent you.If someone is representing you, and you authorize that person to act on your behalf, and you consent to the IPC to contacting them (including through email) and exchanging information about this complaint, please fill out the contact information below. Information about person or organization your complaint relates to Name of person or organization your complaint relates to Name of contact person at the organization, if applicable Address Unit City Province - None -AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal code Phone number Email address File number for your complaint (if applicable) For example, your complaint may relate to a “service provider” organization such as a children’s aid society or a group home, or an individual. Sharing your information We may need additional personal information to process your complaint. Do you consent to the IPC looking at or asking for the personal information we need to process your complaint? Yes No We would like to share your complaint with the service provider you have complained about, so the service provider understands the reasons for your complaint and the IPC can process your complaint.By filing this complaint, you consent to share your name, this complaint form, and all attachments provided with this complaint form to all of the parties to this complaint (including the service provider).If you do not consent to share your complaint information, please explain why below. We will consider whether we can properly address your complaint without sharing this information. Details of your complaint Please select all the boxes that explain why you are making the complaint: The person or organization the complaint relates to has inappropriately collected, used and/or disclosed (shared) my personal information Other… Enter other… Please provide a detailed description of your complaint. Your description should include the what, when, who, how, where and why of what happened. Have you communicated with the service provider about your complaint? If so, please explain. Resolution of your complaint Do you have a suggestion about how your complaint could be resolved?In certain circumstances, the IPC will make an order to resolve a complaint. However, it is important to note that most complaints before the IPC are resolved informally and do not result in an order. The IPC can order a service provider to grant access to requested records, order a service provider to respond to an access request, etc.The IPC cannot order disciplinary measures against employees of the service provider you are complaining about (such as requiring the service provider to fire an employee) or order it to pay you financial compensation (money). Attachments Attachments One file only.100 MB limit.Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip. The following documents have been attached (if applicable): Please attach any documents about your complaint. Option 1Send this form now.Option 2Print the form and email to @email or mail to:RegistrarInformation and Privacy Commissioner/Ontario1400-2 Bloor Street EastToronto, OntarioM4W 1A8What happens next? Someone from our intake team will contact you to discuss your complaint.Find out more about the complaint process.You can also contact our office by email at [email protected], by phone at 416-326-3333, toll-free at 1-800-387-0073 if you have questions. Leave this field blank
Download the PDF version of this form You must have JavaScript enabled to use this form. Your Information Last name First name Middle initial(s) Preferred name Address Unit City Province - None -AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince EdwardQuebecSaskatchewanYukon Postal Code If you consent to the IPC contacting you by phone including leaving a voicemail message, please provide your phone number. If you wish to communicate with the IPC by email, please provide your email address (required) ? Are you: Filing a privacy complaint about your own personal information The substitute decision-maker (such as a parent or guardian) for someone who is filing a privacy complaint about their personal information Substitute decision-maker information If you are a substitute decision-maker (such as a parent or guardian) making a complaint on behalf of someone else, please describe your role and explain your relationship. It may be necessary to provide documentation to prove you are authorized to act for the individual. Please attach this documentation if you have it at the end of this form. Skip this section if you are not a substitute decision-maker. Representative Information Representative is a: Lawyer Other person Last name First name Middle initial(s) Preferred name Address Unit City Province - None -AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Phone number Email address Skip this section if you do not have a representative.You may represent yourself in a complaint to the IPC, or have someone else (such as a lawyer or another person) represent you.If someone is representing you, and you authorize that person to act on your behalf, and you consent to the IPC to contacting them (including through email) and exchanging information about this complaint, please fill out the contact information below. Information about person or organization your complaint relates to Name of person or organization your complaint relates to Name of contact person at the organization, if applicable Address Unit City Province - None -AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal code Phone number Email address File number for your complaint (if applicable) For example, your complaint may relate to a “service provider” organization such as a children’s aid society or a group home, or an individual. Sharing your information We may need additional personal information to process your complaint. Do you consent to the IPC looking at or asking for the personal information we need to process your complaint? Yes No We would like to share your complaint with the service provider you have complained about, so the service provider understands the reasons for your complaint and the IPC can process your complaint.By filing this complaint, you consent to share your name, this complaint form, and all attachments provided with this complaint form to all of the parties to this complaint (including the service provider).If you do not consent to share your complaint information, please explain why below. We will consider whether we can properly address your complaint without sharing this information. Details of your complaint Please select all the boxes that explain why you are making the complaint: The person or organization the complaint relates to has inappropriately collected, used and/or disclosed (shared) my personal information Other… Enter other… Please provide a detailed description of your complaint. Your description should include the what, when, who, how, where and why of what happened. Have you communicated with the service provider about your complaint? If so, please explain. Resolution of your complaint Do you have a suggestion about how your complaint could be resolved?In certain circumstances, the IPC will make an order to resolve a complaint. However, it is important to note that most complaints before the IPC are resolved informally and do not result in an order. The IPC can order a service provider to grant access to requested records, order a service provider to respond to an access request, etc.The IPC cannot order disciplinary measures against employees of the service provider you are complaining about (such as requiring the service provider to fire an employee) or order it to pay you financial compensation (money). Attachments Attachments One file only.100 MB limit.Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip. The following documents have been attached (if applicable): Please attach any documents about your complaint. Option 1Send this form now.Option 2Print the form and email to @email or mail to:RegistrarInformation and Privacy Commissioner/Ontario1400-2 Bloor Street EastToronto, OntarioM4W 1A8What happens next? Someone from our intake team will contact you to discuss your complaint.Find out more about the complaint process.You can also contact our office by email at [email protected], by phone at 416-326-3333, toll-free at 1-800-387-0073 if you have questions. Leave this field blank
