NSW POLICE FORCE P 964

Version 1.1 (06/07)

NSW Police Force Complaint Form

YOUR DETAILS
You are entitled to remain anonymous however you should be aware that NSW Police Force’s ability to
respond effectively to your complaint could be hindered if we are unable to seek further detail or clarification
from you.
Your name

Address Postcode

Phone Email

Your preferred method of contact: Mail Telephone Email Do not contact me

YOUR COMPLAINT
Please describe the incident or conduct that you wish to complain about below, or in an attachment. Provide as much detail
as possible including date(s), time(s), location etc.

Are you able to identify witnesses or provide other evidence of the matter you are complaining of? If so, please provide
details.

What outcome do you want to see, or believe would be appropriate as a result of the outcome of your complaint?

Making a false complaint about the conduct of a police officer is an offence. Providing false or
misleading information during the course of an investigation into a complaint is also an offence.

Your signature: _______________________________________ Date: ______________________________________________

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