Your Information

Name:

Address:

Phone:

Fax:

E-mail:

Publication Information

My complaint is against:
(name of publication/s or URL of website)
1.
2.
3.

Date/s of publication (where applicable):
1.    2.    3.
(in dd/mm/yy format)

Please attach a copy of the article/photo/picture below or mail a copy to P.O Box 10 879, The Terrace, Wellington.

Attachment 1.
Attachment 2.

Main Thrust of the Complaint

State, in 400 words or fewer, the main thrust of your complaint.

Contact with Publication

Have you contacted the publication(s) or website about the matter(s) listed above? If so, in what manner and when?

If not, why not?

What, if any, response have you had from the publication(s) or website?

Principles Breached

Please tick which Principles you consider have been breached.

1. Accuracy
2. Corrections
3. Privacy
4. Confidentiality
5. Children and Young People
6. Comment and Fact
7. Advocacy
8. Discrimination
9. Subterfuge
10. Headlines and Captions
11. Photographs
12. Letters
13. Council Adjudications