Isle of Wight Council

PLEASE NOTE THIS FORM MAY BE SUBMITTED ON-LINE FOR PRE-PROCESSING BUT YOU MAY BE REQUESTED TO SIGN ONE OR MORE COPIES AT A LATER DATE. IF THIS FORM REQUIRES ADDITIONAL DOCUMENTS OR PAYMENTS TO BE ATTACHED THEN YOU WILL ALSO BE REQUIRED TO PROVIDE THESE WHEN REQUESTED ALTERNATIVELY YOU MAY COMPLETE THE FORM ON-LINE AND CREATE A PRINTED COPY. THIS COPY MAY THEN BE SIGNED AND SUBMITTED WITH ANY ADDITIONAL DOCUMENTATION AS REQUIRED.

ACCESS TO INFORMATION Appeals form

Title

*	Forename		*
	Middle name/Initials
*	Surname		*

*	Building/house name/number		*
*	Street address		*
*	Town Name		*
	County
*	Postcode		*
	Home Tel Number (include area code)
	Work Tel Number (include area code)
	Mobile Tel Number
	email address

	Please detail your complaint
	What is your desired outcome?

We need to know how to contact you to resolve your appeal as quickly as possible. Please tell us your preferred method of contact:

Please enter our reference number of the decision you are complaining about? What was the date of the decision you are appealing?

Please enter the Officer's/Councillor's name you previously spoke with?

	Officer/Councillor
	Department
	Have you approached the Officer about your dissatisfaction with this matter?	Yes No
	If so, what was the outcome?
	Are you complaining on behalf of someone else?	Yes No
	If yes, please provide their name and address
	What is your relationship to this person?
	If you are complaining on behalf of someone else we will need to contact them to verify certain details of the complaint. Please enter their preferred contact method.

If you do not wish to submit this form on-line then please return a printed version of this form to Information Management Team at County Hall, High Street, Newport, IW. PO33 1UD Please note that this form may be shown to any Officer, Data Processor or Councillor involved either with the original decision or to enable your complaint/appeal to be processed fully. All personal information provided by you is processed in accordance with the Data Protection Act 1998.

	Data Protection Act 1998
	This application may be monitored by the Isle of Wight Council for regulatory, quality control or crime detection purposes. Information from this application will be processed in accordance with the Data Protection Act 1998 for the purpose of processing your particular enquiry/request. The Isle of Wight Council ("the Council") is the data controller. By completing this form you consent to the Council contacting you by email or nominated contact method in relation to your enquiry/request. The information contained in this application may, in exceptional circumstances, be subject to disclosure to third parties under either the Data Protection Act 1998 or the Freedom of Information Act 2000 to the extent the law allows and in accordance with the Isle of Wight Council's Access to Information Policy . Disclosure will only be made where in all the circumstances it would be fair to do so and in the public interest. Please note that the Council may process your information in the absence of consent for the purpose of crime prevention or detection so far as is in accordance with the law. Sometimes we may use your information to keep you informed about services, goods or relevant issues that we believe may be of interest to you. If you wish to receive this information for these purposes please tick this box To improve the quality of other services that we provide to you the Council wishes to hold your non-sensitive personal information on a secure central database. This will enable all Council services to use this information when they are providing a service to/for you. If you wish your non-sensitive personal information to be held by the Council please tick this box

Date printed: 07/03/2013