Consumer Complaint by deafeningbuzz


									 Consumer Complaint
                                                                                                      Consumer helpline
Before you lodge this complaint you must approach the
                                                                                                      1300 55 81 81
trader/supplier and seek satisfaction regarding your problem.                                         For more consumer information
If you cannot resolve the problem to your satisfaction, please complete both sides of this            visit our website
complaint form and lodge it with Consumer Affairs Victoria.
Note: Consumer Affairs Victoria will encourage both parties to reach a voluntary resolution,
however we do not have the power to make either party accept a particular outcome. If our
actions are unsuccessful, you may need to consider further action, such as applying to the
Victorian Civil and Administrative Tribunal or engaging a solicitor.

1. Your details
   Title (Mr, Mrs, etc)   Family name (surname)                          Given names

   Street address                                                        Suburb                                                  Postcode

   Daytime telephone number                 Mobile telephone number

   Email address (if applicable)                                                   Year of birth (eg 1962)          Gender
                                                                                                                       Male         Female

2. Details of trader/supplier
   Name of trader/supplier

   Street address                                                        Suburb                                                  Postcode

   Daytime telephone number                 Mobile telephone number                Email address (if applicable)

3. Details of any other party involved (eg manufacturer)
   If there are any other parties involved in this dispute (eg manufacturer, sub-contractors), list them here.
   If you need to list more than one other party, please attach a separate list with their details.
   Name of other party                                                                           Daytime telephone number

   Street address                                                        Suburb                                                  Postcode

4. Details of transaction, purchase, agreement or service etc
   Date of transaction          Cost of transaction         Did you borrow money to pay for this transaction?
                                                                                   Name of
           /         /          $                           No         Yes         finance provider

   Provide a brief description of the type of transaction (eg repairs to goods, building renovation, purchase of car, clothing, furniture, etc)

   Description and identification of any goods involved in the transaction (if applicable)
   Make (brand)                             Model                                 Serial or registration number               Type (new or used)

                                                                               Please turn over and tell us about your complaint

Office    Officer                                                               Subject
                                                                                                                                   CAV 44 (15/5/09)

         Conciliation          Investigation/Compliance
         Yes        No         Yes     No
5. Please explain your complaint                   (include dates and any conversations – if you need more space, please attach a separate sheet)

6. What did the trader/supplier offer you to resolve this complaint?

   Who did you speak to? (name of person/s)

7. What remedy are you seeking – how do you want your problem to be solved?
   (if you need more space, please attach a separate sheet)

8. Do you have any written documents to support your complaint?
   (eg receipts, quotes, contracts, invoices or any documents you have served on the trader/supplier or they have served on you)
    No        Go to question 9.
   Yes        Please attach copies of all documents to this complaint form. Go to question 9.

9. Have you contacted or lodged a complaint with another industry or government
   organisation about your problem?
   No           Yes               Which industry/organisation

10. Signature
   I declare that the above information is true and correct to the   Signature
   best of my knowledge. I agree that the information I have                                                          Date
   given in this form may be used or disclosed by Consumer
   Affairs Victoria to process this complaint.                                                                                 /        /

11. How to lodge this complaint                                                        12. What happens then?
   Post this form and copies of any documents to:                                           An officer from Consumer Affairs Victoria will
   Consumer Affairs Victoria                                                                contact you regarding this complaint.
   GPO Box 123 Melbourne VIC 3001
                           or                                                           Privacy
                                                                                        Consumer Affairs Victoria is bound by laws that protect
   Fax both sides of this form and copies of any documents to: 8684 6295                your privacy concerning the collection, use and disclosure
                         or                                                             of your personal information. Where you do not provide
                                                                                        the information required by this form, we may refuse or be
   Deliver in person to: 113 Exhibition Street Melbourne VIC 3000                       unable to process this transaction. We may need to
                         or your nearest regional office                                disclose your personal information to other State and
                                                                                        Commonwealth agencies. You can request access to your
                                                                                        personal information by contacting us. Our privacy
                                                                                        statement is available at

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