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.
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.
Select a title
Other Title (please specify):
select a state
I am attaching a document to this form
Send this file:
Do you need to send us more than three documents?
If you need to attach more than three documents, please send your additional documents by email to firstname.lastname@example.org and tell us in your email that you have submitted a complaint online.
I will be sending relevant documents that support my complaint by:
Given Name(s): *
Your email address: *
Street/Postal Address: *
Your email address:
If yes, please tell us how we can assist you:
If yes, please tell us what language you require:
Referred by agency
Member of Parliament
Ombudsman Regional Visit
If yes, please indicate what your disability involves:
Use of hands/arms
Use of feet/legs
Long term medical, physical or mental condition
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.
Further information about the complaint handling process is available on the Energy and Water Ombudsman WA Information Sheet. You can contact us for advice on 08 9220 7588 or email email@example.com.