Authority to act form | Department of Justice

If you would like someone else to lodge a complaint with the Department of Justice, Tasmania on your behalf, you will need to give your consent by filling out this form and providing a piece of photo ID.

If you have any questions about how to complete this form you can email
complaints@justice.tas.gov.au or call (03) 6165 3653.

Authorisation

Signature Full name Complainant * (name of complainant)

Full name Representative * (name of representative)

Signed *

Date *

Day Month Year

Complainant Name *

Date of birth *

Day Month Year

Address *

Email *

Phone *

Authorised Representative Name *

Date of birth *

Day Month Year

Address *

Email *

Phone *

Confirm Identification The Complainant must attach a current photo ID with signature to confirm their identity

Photo ID *

Last Updated: 24 June 2024