Complaint Form Page 2

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For office use only: Ref. No.
Details of complaint
Please complete these details in full.
Advert Title / Broadcast Item
Date of Broadcast: dd/mm/yr
Time of broadcast (if applicable)
Is the complaint an infringement of:
Please select relevant
category
48 (1)(d) General Commercial Communications Code
48 (1)(d) Children’s Commercial Communications Code (Children’s advertising
refers to advertising that promotes products, services or activities that are deemed
to be of particular interest to children and/or are broadcast during and between
children’s programming. Children’s programmes are programmes that are
commonly referred to as such and/or have an audience profile of which over 50%
are under 18 years of age)
Please complete this section briefly, summarising the main points of your complaint (alternatively,
you may attach your complaint to this form).
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