1. Complainant Information

Please provide your contact details so we can investigate your concern and respond.

Full Name:

Email Address:

Phone Number (optional):

Postal Address (optional):

I am submitting this complaint on behalf of a child or young user (under 18)

YesNo

2. Nature of the Complaint

Please select all that apply:

I believe my personal data was collected without valid consentI was not informed how my data would be usedMy data has been shared without my permissionI requested access to my data, but did not receive itI asked for my data to be deleted but it was notMy data was used for profiling or automated decisions without my knowledgeI was affected by a decision made solely through automated means without meaningful human involvementI was affected by a data breachI have another concern (please describe below)

3. Description of the Issue

Please describe in detail what happened, including relevant dates, communication history, and any supporting information (e.g., screenshots, email references, etc.).

4. Have You Previously Contacted Us About This Matter?

Yes – I contacted your team on:No – This is my first time reporting the issue

5. Desired Resolution

What action would you like us to take in response to this complaint? (Mandatory section)

7. Declaration

I confirm the information provided above is accurate and complete to the best of my knowledge.I confirm that I have read and understood the 42Gears Privacy Policy.

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