BCA complaint form

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BCA complaint form

Your details

Consent for storing submitted data *

Yes, I give permission to store and process my data

Council *

Full name * You cannot make an anonymous complaint.

Job title *

Postal address *

Email *

Phone number *

Who you are complaining about

Name of the practitioner you are complaining about *

Practitioner registration number (if applicable)

Practitioner's company name (if applicable)

Practitioner's email address (if known)

Practitioner's contact phone number (if known)

Practitioner's address (if known)

Trade(s) of concern

Plumbing
Gasfitting
Drainlaying

The work that was carried out

Building consent number (if known)

Date(s) the work was carried out *

Address where the work was carried out *

What work was carried out (please be specific) *

What are the problems with the work that has been carried out? *

Has the work been inspected or fixed by a remedial tradesperson

Yes
No

Name of remedial company

Email for remedial company

Phone number for remedial company

You MUST agree to:

I agree to be named as the complainant *

I agree to sign a statement outlining my complaint * By signing the statement, you must be prepared to attend a Board Disciplinary Hearing or a District Court prosecution if required.

Attachments

Upload supporting evidence Total size of all files uploaded must not exceed 4MB. To select more than one file, please select all the files you want to upload when the open dialog box appears by pressing shift button and then clicking on the file(s) you need. Alternatively, you can email files to compliance@pgdb.co.nz.

Declaration

I declare that the information I have supplied in this form is true and correct. *

I agree to all documentation relating to this complaint being released to the parties involved. *

I understand that all information I provide is subject to public release. * If the Board receives a request for this material they will be required to consider its release, in whole or part, in terms of the criteria set out in the Official Information Act 1982.

Please read the Board's privacy statement before submitting this form. It explains how we collect, use, share and store your personal information, including when we collect it from others or verify it with third parties, and how you access and correct your personal information.

Privacy statement *

I have read the Board's privacy statement.