Reference no:

Regulation 22
Unsolicited Direct Marketing By Electronic Mail
(Text/Picture/Video Messages and Emails)

1. Your Details
Name:
................................................................................................
Address: ................................................................................................
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Postcode:
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If your complaint is about TEXT/PICTURE/VIDEO MESSAGES ...

On what mobile phone number did you receive the communication?
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Are you the subscriber (account holder) for the number?
Y/N

If not who is?
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Please indicate the circumstances for which the number is used

Domestic [ ]
Business - sole trader [ ] Business partnership [ ]
Business - limited company [ ] Other (please specify).......................................

If your complaint is about EMAIL MESSAGES ...

On what email address did you receive the communication?
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What is the number assigned to the line you normally use to access this
email account?

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If your complaint is about EMAIL MESSAGES (contd) ...

Are you the subscriber (account holder) for that line?
Y/N

If not who is?
.............................................................................................................................................
.............................................................................................................................................
....................................................................................................................................
Please indicate the circumstances for which the email address is used

Domestic [ ]
Business - sole trader [ ] Business partnership [ ]
Business - limited company [ ] Other (please specify)..........................................

2. The Identity of the Sender.

Please note
· If there is more than one sender please list the details on a separate piece of paper
· In most instances we cannot pursue a complaint if we are unable to identify the
sender
· If the sender is based outside the UK they are not subject to this legislation.
· If the sender is based outside the EU, they are not subject to the EU Directive on
which this legislation is based.

Their name: ................................................................................................
Their address:.............................................................................................
................................................................................................
Their Tel no: ...............................................................................................
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Their email address:...............................................................

Their website:
..........................................................................................

3. The Text/Picture/Video Messages/Emails
(If there has been a large amount please provide details on a separate piece of paper)

Date(s) received:..........................................................................................
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Please describe the nature and contents of the communication(s)
(In the case of emails, please attach a copy)
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Have you ever given permission for the caller(s)/sender(s) to send direct
marketing
communications
to
you?

Y/N

Have you made any verbal or written requests to stop these
communications?

Y/N

(If you've answered "yes" to either of the above please give details and enclose copies
of any correspondence)

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Have you reported the communications to any other organisation?

Y/N
(If "yes" please specify and provide details of any response you have had)

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Was the message diverted to you from another number or email address?
(If "yes" please give details. We may need to discuss this with you in more detail at a
later date)
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4. Further Action
Has the receipt of these messages had any practical impact on you? (e.g.
prevented urgent message from being received, costs incurred)

Y/N

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In the event that this becomes necessary, would you be prepared to co-
operate with the Information Commissioner with a view to giving evidence
about the subject of your complaint? (This is likely to involve making a written
statement confirming your experiences and may involve giving evidence in person to
the Information Tribunal or to a court)

Y/N
5. Declaration

I have clearly indicated any information which I do NOT wish to be passed onto the
caller/sender of the messages in question.

To the best of my knowledge I have supplied the Commissioner with accurate
information.

Signature ................................................ Date ...........................................

Please return this form to:
The Information Commissioners Office
Wycliffe House
Water Lane
Wilmslow
Cheshire, SK9 5AF

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In order to help us gauge the problems unsolicited commercial communications are
causing it would be helpful if you could forward details or copies of any further
communications you receive from the organisation(s) about which you have
complained, clearly quoting dates on which they were received and any reference
numbers provided by this office.

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