Personal Information Request Form

Please fill in the following form as fully as possible, then click 'submit' at the end of the form.
You can use the TAB key to move to the next field. We will respond to your request as soon as possible.

To allow us to contact and identify you, please complete the following:

Full Name (and company/business name if relevant)

Postal Address / Email Address:

Telephone Number:

Name of GNG contact (if any):

Other contact details of relevance (ie. account number / policy number):

To allow us to understand the nature of your request please complete the following:

	I want to correct incorrect personal information you hold about me
	Please specify below what personal information you believe is incorrect and why and what changes you require

	I want to access my personal information
	Please specify below what personal information you want access to

	I want to make a complaint about the handling of Privacy by the Greater National Group
	Please specify below what the complaint is, which GNG personnel or office is involved so we can assist you in resolving your complaint.

	I want more information about GNG's practices on handling and management of personnel information.
	Please specify below what additional information you require.

	I want to opt out of receiving marketing information
	Please specify below what information you want to opt out of receiving.

Other

Specify your request details

In relation to any of the above please identify if your request is urgent and the reason for its urgency. In most cases we will be able to contact you within 15 business days to either provide you with an answer or explain what we are doing in relation to your request. We may need to apply a charge for the costs of our providing access to information in certain situations. We will let you know what this is before we provide access.

Privacy Officer Contact Details:

Organisation	Contact	Fax. No.
GNG	Jane Sinclair	(03) 9572 5655

Greater National Group Personal Information Request Form