Online Complaint Form

Please read information in the Making a complaint section before completing this form. If you still have any queries please ring us on (08) 9220 7588 or Toll Free on 1800 754 004.

Entries marked with * must be completed.

Tell us about your complaint

Are the contact details for the account holder the same as the contact details for the complainant?

     

If you answered yes, please go to the next section to tell us about the complaint .

If you answered no, please provide the Account Holder's details below before telling us about your complaint.

Supporting Documentation

If you want to send a relevant document, you can attach a document to this form or send it by post, email or fax:


I will be sending relevant documents that support my complaint by:

Your contact details

Please provide us with your contact details below. Please note that your name and address must be provided in order to submit your complaint.

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Representative's Contact Details

If you want someone to represent you regarding your complaint, please give us their contact details below.

Do you require help to access our services?

Do you have an ongoing disability that means you require assistance to access our services?

     


Do you need a translator?


 

How did you find out about the Energy and Water Ombudsman?

Please choose an option from the list below:














 

Other information about you

By filling in this information, you will be helping us ensure our services are available to all of the Western Australian community. The personal information you provide is confidential to our office. Any information we release will only identify groups to analyse access by different members within the community. The analysis will not provide any information about individuals. While we would appreciate your responses, you are not required to fill in this part of the form.
Gender:

    

Are you of Aboriginal or Torres Strait Islander origin?

      

What is the primary language spoken at home?

   

Do you have an ongoing disability?

      

If yes, please indicate what your disability involves:


      





 

Submit your complaint

Please check that the details are correct. To clear all information, click on the 'Reset' button. If you are satisfied with your submission, click on the 'Submit' button to send us your complaint.