Fillable Printable Service Feedback Form - Ottawa

Service Feedback Form - Ottawa

63-0007E (1411-02)

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Address (Street or Postal Box)

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Headquarters / Ottawa

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Complaint Compliment Comment

SERVICE FEEDBACK FORM

Please select one (required)

A service complaint is an expression of dissatisfaction with the service, quality, or timeliness of the work performed by Transport Canada

Part One - Identification and Mailing Address (required)

Part Two - Information about the group or unit you were dealing with (please select one for group and one for location) (required)

Part Three - Nature of Complaint, Comment or Compliment (required)(select one from dropdown list)

Part Four - Complaint

Given name

City

Postal Code

Province or Territory

Email Alternative Telephone Number Daytime Telephone Number

Surname

Nature of Complaint, Comment or Compliment

Protected A when completed

1. Describe your service-related complaint (required if complaint is selected)

2. What actions have you taken to try to resolve your service-related complaint?

63-0007E (1411-02)

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3. Describe the outcome you want (required if complaint is selected).

4. Feedback: What do you think we should do to improve our service?

Part Five - Comment or Compliment

1. Give details of your comment or compliment (required if comment or compliment is selected)

2. What do you think we should do to improve our service?

Part Six - Signature and Certification (required)

I authorize Transport Canada to review my complaint, comment or compliment. I further certify that the information given on this form or in the attached

document is, to the best of my knowledge, correct and complete.

Signature

Date

Completing and Submitting Form

You can return the form to the following address:

Transport Canada - Service Feedback (AAEZ)

330 Sparks Street

Ottawa, ON

K1A 0N5

Or by fax: 613-954-4731

For more information you can reach us at:

Phone: 613-990-2309

Toll Free: 1-866-995-9737

Teletypewriter (TTY): 1-888-675-6863

The personal information provided on this form is collected under the authority of the Financial Administration Act. Providing information on this form is voluntary.

This information is required to respond to your comments and/or complaints, as well as to help the department improve service delivery. The personal information

collected is described in a Personal Information Bank entitled Outreach Activities TC PSU 938. Under the provisions of the Privacy Act, individuals have the right

of access to, correction of and protection of their personal information. All personal information provided on this form will be handled in accordance with the

provisions of the Privacy Act and other applicable laws. Please do not disclose information that is considered confidential.

I do not require a response from Transport Canada to this complaint, comment or compliment

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