Approved Form No: …

6A.
Raise a concern about a
charity
Purpose
Use this form to tell the ACNC if you have a serious concern
about a charity.
Section B: About you
4
What is your relationship, if any, to the charity? (for
example, volunteer, client, staff member)
You can also raise a concern about a charity by
telephoning the ACNC or sending us your concern in
writing.
The ACNC does not deal with all concerns relating to
charities, and gives priority to dealing with certain
kinds of concerns. For more information, see our
Complaints about charities policy.
Instructions




This form is fillable on your computer using the free
Adobe Acrobat Reader.
You can also choose to print the blank form and fill it
out by hand.
Answer as many questions as you can.
Attach any additional information to this form (for
example, if you need more space).
Section A: Charity information
5
Your contact details
Providing your contact details is optional, but will
assist us should we need to contact you for additional
information to evaluate your concern.
This information is for the ACNC’s use only. Your
personal details will not be provided to the charity that
is the subject of your concern.
Title
Mr
This information will help us to identify the charity that
is the subject of your concern. You will find this
information on the ACNC Register.
1
What is the charity’s Australian Business Number
(ABN), if known?
2
What is the charity’s name?
O
Mrs
O
Miss
O
Ms
O Other
Family name
Given name(s)
Preferred phone number (landline or mobile)
If possible, provide the charity’s formal name as it appears on the
ACNC Register.
Email address (preferred)
Postal address (street address or PO Box)
3
Are there any other details that will help us identify
the charity?
Suburb or town
State
Postcode
PAGE 1 OF 3
6A.
Raise a concern about a
charity
Section C: Your concern
Providing this information is important to help the
ACNC understand your concern and decide whether
we will take action. If we decide to take the matter
further, this information may be provided to the charity
unless you indicate otherwise.
6
Explain your concern about the charity
Provide as much detail as you can. Information that is useful includes:
 the nature of your concern
 how you learnt of the concern
 past events and dates
 names of people involved, including any individuals who can support your version of events or have expressed similar concerns
 documents or other evidence that would support your concern
 whether you have raised this concern with anyone else, including the charity itself or a government agency
 how you want the matter to be resolved.
Attach more pages if required.
Thank you for raising your concern with the ACNC.
We will notify you when we have received and
evaluated your concern. In some cases, we may
contact you for additional information. However, the
ACNC Act prevents us from telling you about what, if
any, response we decide to take.
PAGE 2 OF 3
6A.
Raise a concern about a
charity
Section D: Privacy and lodgement
Privacy
We are collecting the information in this form for the purpose
of administering the Australian Charities and Not-for-profits
Commission Act 2012 (Cth). We will use this information to
evaluate your concern. You are not required by law to
provide us with any of the information requested on this form.
However, providing this information will assist us in
evaluating your concern. Where authorised to do so, we
may give this information to other agencies (for example,
through the Charity Passport). Your personal details will not
be provided to the charity that is the subject of your concern.
The ACNC’s privacy policy is available on our website
(www.acnc.gov.au). The policy contains important
information about how you can access and request
correction of information we hold about you, how you may
complain about a breach of the Australian Privacy Principles
and how the ACNC will deal with any privacy complaint. If
you have any questions, our contact details are
[email protected], 13 22 62 or GPO Box 5108 Melbourne
Victoria 3001.
Lodging this form
Email it to:
[email protected]
Send it to:
Australian Charities and Not-for-profits Commission
GPO Box 5108
MELBOURNE VIC 3001
Fax it to:
1300 232 569
For information call Advice Services on:
13ACNC (13 22 62)
PAGE 3 OF 3