Section 1: Verification
1. To qualify for consideration under the EU-U.S. Privacy Shield Framework, complaints must originate from consumers or businesses in one of the participating EU Member States. Please mention which country your complaint originates from:
2. Your complaint must involve a data privacy concern involving transfer of personally identifiable information (name, address, email address, phone, account information, etc.) from Europe to the United States. If it does not, this issue does not appear to be a data privacy complaint under the Privacy Shield Program.
Does this complaint involve a data privacy concern involving transfer of personally identifiable information from Europe to the United States?
Section 2: Authorization
Before filing your complaint, please note:
1. Do you consent to the processing and sharing of my personal data under the terms stated above:
Section 3: Complainant’s Contact Information
1. Name (First Name, Last Name):
3. Mailing Address:
A. Street Address
B. Street Address Line 2
C. City, State / Province
4. Phone Number (Area Code / Phone Number):
Section 4: Nature of Complaint
1. Please provide a brief and well detailed overview of your concerns demonstrating lack of compliance with the Privacy Shield Principles (https://www.commerce.gov/privacyshield) such as concerns about sharing, use or protection of personal data, not honoring your opt-out requests etc.:
2. Please elaborate on the reasons why you believe that the Privacy Shield Principles were not complied with:
3. What resolution or further information are you seeking:
4. Any other detail you think will be helpful (optional):
NOTE: If you wish to provide any supporting documentation (such as email correspondence, screenshots or other relevant materials) that demonstrate lack of compliance with the Privacy Shield Principles, please send them named and labeled over to firstname.lastname@example.org. Thank you.