Request a review of the casework decision on your complaint

Section A - Your Details
The person who submitted the complaint, or who experienced the problem with our service, should normally fill in this form. If you are filling this form in on behalf of someone else, please also complete Section B.

Name

First Last

Address

Street Address Address Line 2 City County Postcode

Email

Enter Email Confirm Email

If you provide an email address we will normally use this for correspondence.

Daytime contact number

Mobile number

Ombudsman’s case reference number(s) if known

Section B
If you are requesting a review on behalf of someone else, please provide their details.

Their name in full

First Last

Their address

Street Address Address Line 2 City County Postcode

What is your relationship to them?

Why are you acting on their behalf?

Section C
Your request for a review of a decision taken by the Ombudsman

What was the date of our decision?

If it was more than 20 working days ago, please explain why your review request has been delayed.

What new evidence do you have?

Why do you think we have not properly considered your complaint?

What evidence do you think we have not taken into account and how do you think it affected our decision? You will need to explain this for each aspect of your review request.

Remember: we will not be able to look at your review request if you simply disagree with our decision. If you have documents to support your request, please submit them with this form, on the next page.

Section D
Please list any documents attached or provide any additional information

File

Max. file size: 40 MB.

File

Max. file size: 40 MB.

File

Max. file size: 40 MB.

File

Max. file size: 40 MB.

File

Max. file size: 40 MB.

Provide any additional information here

If you need to attach more than 5 documents, please email them to review.requests@ombudsman.wales

We will acknowledge your form within 5 working days of receipt.

Date

Information:

Complaints About:

Other Organisations:

About us:

Requesting:

Other:

Publications:

Case Findings:

Plans and Reports:

Other Documents:

Request a review of the casework decision on your complaint

Online form to review a decision by the Ombudsman about a complaint

Section A - Your Details
The person who submitted the complaint, or who experienced the problem with our service, should normally fill in this form. If you are filling this form in on behalf of someone else, please also complete Section B.

Section B
If you are requesting a review on behalf of someone else, please provide their details.

Section C
Your request for a review of a decision taken by the Ombudsman

Section D
Please list any documents attached or provide any additional information

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Information:

Complaints About:

Other Organisations:

About us:

Requesting:

Other:

Publications:

Case Findings:

Plans and Reports:

Other Documents:

Request a review of the casework decision on your complaint

Online form to review a decision by the Ombudsman about a complaint

Section A - Your Details The person who submitted the complaint, or who experienced the problem with our service, should normally fill in this form. If you are filling this form in on behalf of someone else, please also complete Section B.

Section B If you are requesting a review on behalf of someone else, please provide their details.

Section C Your request for a review of a decision taken by the Ombudsman

Section D Please list any documents attached or provide any additional information

Section A - Your Details
The person who submitted the complaint, or who experienced the problem with our service, should normally fill in this form. If you are filling this form in on behalf of someone else, please also complete Section B.

Section B
If you are requesting a review on behalf of someone else, please provide their details.

Section C
Your request for a review of a decision taken by the Ombudsman

Section D
Please list any documents attached or provide any additional information