Consent to share information – complaint

Section 1: Consent to Share (the person with the complaint)

I, (name)(Required)

First Last

born on (DOB)(Required)

of Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Give my written consent for Homes Tasmania to obtain relevant information about me from organisations and/or individuals that will assist Homes Tasmania investigate the complaint.

Section 2: Do Not Consent to Share

By completing this section, there are some organisations/individuals that I do not want you to ask for information about my complaint

(We understand if you don’t want us to ask some organisations/individuals for information about your complaint however it may limit what we are able to do about your complaint.)

Section 3: Nominated Person (the person helping make the complaint)

By completing this section, I am giving consent for any conversation to take place about my complaint with:

Name(Required)

First Last

Relationship to tenant(Required)

Phone(Required)

Email(Required)

Section 4: Signature Declaration and Authorisation

I understand that the disclosure of information will only be used, given and received to what is relevant to investigating my complaint with Housing Tasmania and
I understand that I can change my mind at any time and revoke or vary consent to share my information. All personal information about me is kept in accordance with the Personal Information Protection Act 2004.

Signature(Required)

Date(Required)

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