Resolution Form

Do you disagree with a decision or want to make a claim for a credit or refund?

Please complete the form below, on behalf of the customer, to raise a dispute with management. Their request will be acknowledged within 3 business days.

First name *

Last name *

Email *

Telephone *

Date of birth *

Preferred contact method *

Telephone

This form is being completed to: *

Raise a dispute

Make a claim for credit

Briefly describe your dispute / what you are wanting to claim *

I understand that this is a request only and in no way is an agreement to undertake or accept the request. *

Evidence to consider attached

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Form completed by *

Please confirm you are a person. *

Privacy

The personal information requested is required primarily for the provision of the service referred to on this form and will only be shared with those directly responsible for providing that service. If you do not provide the information, we may not be able to deliver the service. If you would like to know more about privacy at Glen Eira City Council, including your right to seek access to any information collected on this form, please visit our Privacy page or contact Council’s privacy officer on 9524 3333.

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