You are entitled to remain anonymous however you should be aware the NSW Police's ability to respond effectively to your complaint could be hindered if we are unable to seek further detail or clarification from you. Your Details Your first name Your surname Your residential address Your postal address Phone Your E-mail Your preferred method of contact: Mail Telephone Email Do not contact me Your Complaint Name(s) of Police Officer(s) Involved (if known) Where officer(s) stationed: (if known) Name(s) of other people involved: Incident Date (Format is (circa) DD/MM/YYYY HH:MM am/pm): (if the exact date is not known, an approximation is sufficient eg. circa 1 July 2007) circa.12345678910111213141516171819202122232425262728293031 JanFebMarAprMayJuneJulyAugSeptOctNovDec 2006200720082009201020112012201320142015201620172018201920202021202220232024202520262027202820292030203120322033203420352036203720382039204020412042204320442045204620472048204920502051205220532054205520562057205820592060206120622063206420652066206720682069207020712072207320742075207620772078207920802081208220832084208520862087208820892090209120922093209420952096209720982099 010203040506070809101112 :000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 ampm Place of Incident: (street, suburb, area, locality etc...) Details of Incident(s): Are you able to identify witness or provide other evidence of the matter you are complaining of? If so please provide details. What outcome do you want to see, or believe would be appropriate, as a result of your complaint. Please confirm the details you entered are accurate. Making a false complaint about the conduct of a police officer is an offence. Providing false or misleading information during the course of an investigation into a complaint is also an offence. ^