Submit an Appeal:

All fields are required unless otherwise stated.

Your first name:
Your last name:

Your email address:
Your email address will only be used to contact you in relation to your Request for Facilitation.

RESPONDENT:

Respondent name:

Respondent contact email address:

FACILITATION/COMPLAINT DETAILS:

Date request for facilitation was raised:

Date formal complaint was raised:

Date of outcome:

Outcome details:

NEW EVIDENCE OF SIGNIFICANT NATURE:

Will this new evidence change the outcome of your request for facilitation or formal complaint?:

Provide full details of the new evidence:

How will this evidence change the outcome:

Please enter any FURTHER INFORMATION relevant to your Appeal? (optional):

By submitting this form, you confirm that you give authority for the information submitted on this form and any further information provided to support your Appeal to be stored and processed in the Ombudsman Service Register of Complaints, Outcomes, and Sanctions.

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Currently all information provided by and correspondence with the IRCM is in English.