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Your Comment, Compliment or Complaint
Please Tick Appropriate Box
Do you want to make a:
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Complaint?
Title:
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Other(Please state)
Surname:
First Name(s):
Address:
Postcode:
Contact Telephone Number:
Email Address
Which Service or Establishment would you like to bring to our attention?
How would you like us to contact you? (E.g. phone, email, post)
Ethnic Origin
Bournemouth Borough Council has a policy to promote diversity. To make sure we are treating everyone fairly please tick the box that describes you best:
White
Asian or Asian British
British
Indian
Irish
Pakistani
European
Bangladeshi
Portuguese
Any Other Asian
Eastern European
Any Other White
Black or Black British
Caribbean
Mixed
African
White & Black Caribbean
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White & Black African
White & Asian
Other Ethnic Groups
Any Other Mixed
Chinese
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Any Other Ethnic Category
Do you consider yourself to be disabled? Yes
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If yes, please specify:
Summary of Comment, Compliment, or Complaint
If applicable, what action would you like to see taken about this matter?
This form will be used as away of bringing something to our attention about the services we provide. This information may be shared across departments within the Council. The Council may hold the information you provide in both computerised and manual recording systems, in compliance with the Data Protection Act 1998. If you want to see a copy of the information held about you, you can apply to the Councils Data Protection Officer. For further information, please ask for a copy of the Councils leaflet 'Data Protection Act - Our Commitment to you and Your Rights'.
Please help us to validate this form by entering the words displayed in the box opposite. alternatively there is an audio option for those with visual impairment.
Contact details
Bournemouth Council
Town Hall,
Bourne Avenue
Bournemouth
BH2 6DY
(
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Tel: 01202 451451
Fax: 01202 451000
Minicom: 01202 454728
Email:
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Page Updated: 17 Jun 2008
