Complaints-assisted

By filling up this complaint form, you hereby sworn that you are the complainant and you will have to appear in the office for oath taking. Willful and deliberate assertion of falsehood will be criminally prosecuted. List of accepted government issued ID’s:
  • Philippine Passport
  • Philippine Driver’s License
  • PRC ID
  • Postal ID
  • Voter’s ID
  • GSIS Card
  • SSS Card
  • TIN Card
  • Student ID

Answer the following questions. Do not leave any field blank.

Do you have a concern about a privacy violation, personal data breach or matters related to personal data protection, or any other violation of the Data Privacy Act, its IRR and other.
YES. Proceed to the next section.If NO, do not proceed. The National Privacy Commission may have no power to act on your complaint. The Commission can only act on matters that relate to the Data Privacy

Does your concern affect you personally or it involves your personal data?
YES. ProceedNO.

Options: Filing on behalf of another personRequest for an advisory opinion

Have you contacted the agency/individual you are about to complain?
YESNO

Complainant Personal Information
Firstname

Middle Name

Lastname

Valid ID

ID Number

Present Address

Permanent Address

Email Address

Contact Number

Respondent's Information (Party Complained Against)
Name

Postal Address

Contact Number

Website (if any)

Complaint
Describe the complaint

What personal information about you was affected?

Date of the incident

Time of the incident

Place of the incident

Do you know who did it?
YesNo

List the names (one per line)

How and when did you find out about it?

How have you been affected?

What would resolve this complaint for you?
You may select more than one item. Please explain and enter it to the designated textboxes. Unchecking a checkbox will remove the contents of a textbox.

Are you seeking an Order to temporarily or permanently stop the processing of your data?
YesNo


I hereby certify that all the above information is true and correct to the best of my knowledge and belief.