REPUBLIC OF RWANDA
NATIONAL CYBER SECURITY AUTHORITY
DATA PROTECTION & PRIVACY OFFICE
COMPLAINT FORM
SECTION 1 – PARTICULARS OF COMPLAINANT
Names:
ID Number / Passport Number:
Address: (Province, District, Sector, Cell, Village)
E-mail address (if available):
Phone Number:
Complaint is against: (name of the data controller1 or data processor2)
Contact Person: (name of your contact person at the data controller or data processor)
1
Data Controller means natural person, public or private corporate body or legal entity which, alone or jointly with others, processes personal data and determines the means
of their processing.
2
Data Processor means public or private corporate body or legal entity, which is authorised to process personal data on behalf of the data controller.
1
SECTION 2- DESCRIPTION OF COMPLAINT
Description (Provide facts in chronological order and clarify the
Circumstance (Tick as appropriate)
remedy/action that you seek)
☐ You are concerned about how your information is secured.
☐ An organization will not give you details on information it has about you.
☐ An organization is holding information about you that is inaccurate or incomplete and
has not made corrections when requested.
☐ An organization has not honored your request to destroy or delete a record of your
personal data held by them which is inaccurate, irrelevant, excessive, out of date,
incomplete, misleading, obtained unlawfully or they no longer have the authority to
retain.
☐ Your personal details have been shared with another organization without your
consent or no legal basis for doing so.
☐ Your personal details have been used for direct marketing without your consent.
☐ The organization has not given you enough information to enable you make an
informed consent prior to the collection of your personal data.
☐ An organization collects and uses your personal data without your prior consent in
circumstances that required them to obtain your consent.
☐ An organization collects or uses personal data relating to children without obtaining
prior consent of the parent or guardian or any other person having authority to make
decisions on behalf of the child.
2
☐ Your request to an organization to stop using, holding, storing or sharing your
personal data has not been honored and this has led or likely to lead to your distress or
cause you unwarranted substantial damage.
☐ An organization makes an automated decision without any human involvement and
such decision has a significant adverse effect on you in relation to your personal data.
☐ You become aware of an organization collecting or using your personal data and it
does not have a complaint handling system to deal with complaints from individuals
whose information is collected and used.
☐ An organization is using your personal data for a purpose other than one for which
your information was collected and that new purpose is not compatible with the original
purpose, and neither have you given your consent in relation to the new purpose.
Others: Please specify
Notes: 1. Provide supporting evidence (provide any relevant document, recording, link or screenshot that could help to handle your complaint).
2. Please convert all documents including form into PDF, zip, and send them to complaint@dpo.gov.rw and copy dpp@ncsa.gov.rw.
Name: ………………………………………………………… Signature and Date : …………………………………………..…….
