Feedback

Personal Particulars

Name: * Gender: * Male Female Contact No.: *

Mobile No.:

+65

Office / Residential:

+65

Email: *

Case Details (The location which you wish to give the feedback on)

Subject: *

For Others, please elaborate

Blk No: *

Unit No: *

Street Name: * Reported Location: Comments: Attachment:

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Important:
By submitting this form, I agree that the Town Council may collect, use and disclose all information as contained in this form for the following purposes:

to provide me with information as requested;
to respond to enquiries made or purportedly made by me;
to compile and analyse feedback for internal use only; and/or
to contact me to request for more information where required.

I further agree that the Town Council may disclose any or all of such information to:

its affiliates, service providers and agents for the above purposes;
public agencies for funding, reporting, statistical, research and survey purposes; and
the Member of Parliament for Bishan-Toa Payoh GRC for communication purposes.

I warrant that where I have disclosed personal data of other individuals in connection with this application, I have obtained the prior consent of such individuals for the Town Council to collect, use and disclose such data for the above purposes.