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General Non-Compliance Complaint Form

Instructions: This form helps an individual to submit a general non-compliance complaint to The Office of the Privacy Commissioner for Bermuda (“PrivCom”); in accordance with the Personal Information Protection Act 2016 (“PIPA”). A general non-compliance complaint highlights concerns about an organisation’s overall compliance with Part 2 of PIPA (General Principals and Rules). The outcome focuses on ensuring the organisation’s overall compliance with PIPA, it may not provide a specific remedy to an individual.

 

Note: This form is not intended to be used to submit a formal written request following the submission of a PIPA Rights Request to an organisation. If an individual wishes to submit a formal written request, more information can be found here: https://www.privacy.bm/submit-a-request

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If extra support is needed to complete this form and/or understanding individuals’ rights under PIPA, please contact PrivCom’s Investigations Unit: investigations@privacy.bm or (441) 543-7748.

 

Privacy Notice: Following submission of a written request to PrivCom, we shall provide a copy of it to the organisation concerned and any other person considered appropriate. PrivCom may redact any information contained in the written request that is considered appropriate prior to providing a copy of it to the organisation or any other individual affected by it.

1. Does your written request to PrivCom concern only your personal information?
Yes
No

If 'Yes' is selected, you may need to submit a formal written request to PrivCom.

2. Have you raised your concerns or complaints with the organisation?
Yes
No

The organisation should be given an opportunity to resolve your concerns prior to submitting a written request to PrivCom. PrivCom has the sole discretion to decide on whether to investigate a matter.

  1. Applicant Details

Please indicate the best time to contact you, as well as any other contact restrictions. PrivCom office hours are Monday to Friday, from 9:00 a.m. to 5:00 p.m. AST

Applicant Address

  1. Organisation Details

Organisation Address
6. Please include copies of the following documents if you have them:
7. By submitting this written request:

If you do not agree with either of the above, PrivCom will consider the request invalid, and will not proceed with this matter.

9. Date
Day
Month
Year
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