Office of the Data Protection Commission

Application for Alternative Dispute Resolution

In accordance with Art. 159(2)(c) of the Constitution and Sec. 9(1)(c) of the Data Protection Act, 2019

Purpose & Notes:

To apply for ADR proceedings in accordance with Constitution of Kenya, Data Protection Act, and Regulations.
Where the space provided is insufficient, please use an extension page and attach it to this form.
Completed forms and attachments should be delivered to the Registry or emailed to ADR@ODPC.GO.KE.

A: DETAILS OF COMPLAINANT (For correspondence)

Full Names

Telephone No.

Name of Agent(if not the applicant)

Agent Telephone No.

Email Address

B: ADDRESS FOR DELIVERY OF DOCUMENTS

Registered business name or name of Respondent/Agent

Postal Address

Code

Physical Address

Business Email Address

Business Telephone Number

C: STATUS OF DISPUTE

Lodged with ODPC

Complaint Number

In Court (High/Appeal)

Court Reference Number

If 'Other', please specify

D & E: NATURE & GROUNDS OF DISPUTE

Nature of dispute:(Kindly give a brief description of the Dispute if not already lodged with ODPC)

Grounds for ADR Application

F & G: ATTACHMENTS

Upload Appeal Documents Memo of Appeal, Facts, Commissioner's decision etc.

Settlement Proposal (If any)

No. of pages attached to this form

I & J: DECLARATION & COMPLETION

I hereby apply that the above matter be admitted for resolution through ADR and declare that:

I have fully stated the ground upon which ADR is being applied for.
I have provided relevant documentation in support of my application.

Full Name (s)

Title

Date

I confirm that the information provided here is accurate

Please preview your details

Complaint Details

Raise Complaint

A. PARTICULARS OF THE COMPLAINANT/REPRESENTATIVE

B. PARTICULARS OF THE RESPONDENT

C. PARTICULARS OF THE COMPLAINT

D. REMEDY SOUGHT

Application for Review to ODPC

A. PARTICULARS OF THE PERSON ISSUED WITH THE ENFORCEMENT NOTICE

B. REFERENCE NUMBER OF THE ENFORCEMENT NOTICE