Form # SPD 0806 January 8, 2015
Ministry of Public Safety and Solicitor General
Policing and Security Branch, Security Programs Division
PO Box 9217 Stn Prov Govt, Victoria BC V8W 9J1
Phone: toll-free 1-855-587-0185 Fax: 250 387-4454 Email: guideandservicedogs@gov.bc.ca
Website: http://www2.gov.bc.ca/gov/content/justice/human-rights/guide-and-service-dog
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COMPLAINT FORM
Guide Dog and Service Dog Act
To make a complaint, complete this form and email it to SPDCOMP@gov.bc.ca or mail it to: Security Programs Division, PO Box
9217 Stn Prov Govt Victoria, BC V8W 9J1. If you mail the form, please write “Attention: Compliance and Enforcement” on the
envelope.
PART 1: COMPLAINANT CONTACT INFORMATION
Complainant's Name
Surname Legal Given Name Middle Name
If you have been asked to complete this form on behalf of the complainant named above, what is your relationship to the
complainant?
Friend Relative Other (describe):
Your Name
Surname Legal Given Name Middle Name
Your Telephone Number Area Code & Phone No.
Complainant's Residential Address
Residential Address City Province Postal Code
Complainant's Telephone Number
Area Code & Phone No.
Email
If we need to speak with you, what is the best time to call you? (Time) am pm
If we have trouble reaching you, may we leave a message at a particular number?
Yes, at phone number:
I understand this complaint may be cancelled if we are unable to contact you within 30 days of filing this complaint
PART 2: COMPLAINT DETAILS
Please select what your complaint is in regards to:
Complaint about offence-related matters (false representation, public access rights issues, tenancy rights issues)
Complaint about Dog & Handler Teams
Complaint about Discriminatory Strata Council Bylaws
Complaint related to section 23.1 of the Prevention of Cruelty to Animal Act (harm or interference of a Service animal)
Other:
Particulars of the incident. Please describe the incident as completely as possible. Provide Information such as address, phone
number, name of individual, name of business, name of strata property, guide dog or service dog certificate # (as applicable).
Attach another page if necessary.
Date: YYYY MM DD
Time Incident Ocurred
am pm
Location
I certify that the information provided is true to my knowledge.
Printed Name Signature Date Signed
Collection Notice: The use of this information will comply with the Freedom of Information and Protection of Privacy Act. If you have questions
regarding the collection or use of this information, please contact a Policy Analyst at 1-855-587-0185 or the address below.
click to sign
signature
click to edit
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