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Complaints Form

Contact Details
Given Name
Surname
Address
Daytime Contact Number
Email
Details of Complaint
Time & Date of Incident
(dd/mm/yyyy)
Location of Incident
Who / what is the subject of your complaint?
Summary of Complaint
Witness Details
Name of Witness
Contact Number
Complaint Outcome
As a result of making this complaint, is there any outcome you would like?
If Yes, please provide details
If you see this, leave this form field blank.

Send a copy of the submitted form to this email address.

Light Regional Council
93 Main Street (PO Box 72)
Kapunda SA 5373
Contact
Tel: (08) 8525 3200 | Fax: (08) 8566 3262