Corporate Complaints Manager

Return To: City and County of Swansea

Complaints Team

The Guildhall

Swansea SA1 4NR

COMPLAINTS PROCEDURE – APPOINTMENT OF A NOMINATED REPRESENTATIVE TO ACT ON YOUR BEHALF

This form should be used ifyou want to complain and would like someone to act on your behalf. If you give your permission for a representative to act on your behalf, you MUSTcomplete this form on both sidesand return itto the address shown above.

Once we receive this authorisation from you, we candealwith issues made on your behalf by your authorised representative.

In signing this form, the Authority will liaise with your authorised representative directly instead of you, unless you tick the box below asking us to keep you informed. Even if you do not tick the box, we reserve the right to contact you directly in any event if we consider it necessary to do so.

Appointing a representative does not prevent you from liaising directly with the ComplaintsTeam should you wish to do so.

Your full name: ………………………………………………………………………

Your address: …………………………………………………………………………

……………………………………………………… Postcode: ……………………..

Your contact number: ………………………………......

Your email address: ………………………………………

I authorise the nominated representative named below to act on my behalf in the presentation and resolution of a complaint:

Representative’s full name: ………………………………………………………….

Representative’s address: …………………………………………………………..

……………………………………………………… Postcode: ……………………...

Representative’s contact number: …………………………………………………

Representative’s email address: …………………………………………[TURN OVER]

Relationship between

Applicant and Representative: …………………………………………..

This document provides the City and County of Swansea with my explicit permission for them to receive information on my behalf and provide appropriate responses to myNominated Representative.

In giving this permission, I agree to the sharing of information which, if relevant, may be of personal or private nature, including sensitive data as defined by the General Data Protection Regulations 2018.

Cancellation of an authority to act can be made at any time and must be made by the Applicant in writing to the address at the top of the page.

Signatureof

Applicant …………………….…………… Print Name ………….……………..…......

Date ……………………

Signature of

Nominated

Representative………….………………….. Print Name ………..…….……………......

Date ……………………

Please tick this box if you require copies of all correspondence regardingthe complaint process emailed to you / sent to your address. Where this is required copies without covering letters will be provided for client information only.

This form should be returned to the address above. Please ensure that a copy of the complaint to be progressed is provided and countersigned by our client.

Further consideration and the timeframe has been deferred until receipt of the completed form.

Should you not wish to pursue the complaint further your advice would be appreciated or the matter will be closed 1 month from the issue of this notice.

Swansea Council is the data controller for the personal information you provide on this form. Your information will be used in the exercise of our official authority and will not be used for any other purpose. We will not share your data with third parties unless we are required or permitted to do so by law.

Data protection law describes the legal basis for our processing your data as necessary for the performance of a public task. For further information about how Swansea Council uses your personal data, including your rights as a data subject, please see our corporateprivacy noticeon our website.

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