OFFICE USE ONLY
Date application received:  
   File reference:  
Government Information (Public Access) Act 2009 (NSW)
FORMAL ACCESS APPLICATION
INFORMATION FOR APPLICANTS 
• Summary incident related report: NSW Rural Fire Service
• Consultation with third parties: if the information you are
(NSW RFS) usually provides access to the ‘Fire Incident
seeking access to:
Reporting System (FIRS) Summary Report’ free of charge
1) contains personal information of third parties;
through the State Operations Centre. If you are seeking
access to this document only, please make a separate
2)  concerns a third party’s business, commercial, professional
application for this report using the process set out on our
or financial interest;
website at www.rfs.nsw.gov.au
3)  concerns research carried out by or on behalf of a third
• Application fee: if you can demonstrate financial hardship
party; or
(Pensioner or Centrelink card) the NSW RFS will reduce
4)  affairs of a government of the Commonwealth or another
the application fee by 50%. Please attach proof of financial
State;
hardship with your application.
the NSW RFS may be required to consult with the
• Scope of your application: clearly outline the information
relevant third parties. This increases the decision period
you are seeking and provide sufficient detail to identify the
for processing your application and may increase the
information requested. This may streamline the processing of
processing costs. If you wish to exclude information
your application. Further, if you are seeking incident related
requiring consultation from the scope of your application
information on behalf of a third party (for example if you are
in order to avoid an extension in the decision period or
an insurance company and seek information on behalf of an
reduce processing charges please note this in your request.
insured party) please specify this in your request.
Please complete this form to apply to make a formal application to access government information in NSW from the NSW RFS 
under the Government Information (Public Access) Act 2009 (NSW) (GIPA Act). If you need assistance with completing this form, 
please contact the Right to Information Officer on 02 8741 3480 or visit our website at www.rfs.nsw.gov.au.
GOVERNMENT INFORMATION
Please describe the 
information you would like 
to access in enough detail 
to allow us to identify it. 
Note: If you do not give 
enough details about the 
information, the NSW RFS 
may refuse to process your 
application.
GOVERNMENT INFORMATION (PUBLIC ACCESS) ACT 2009 - NSW FORMAL ACCESS APPLICATION
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FOR GENERAL INFORMATION ABOUT THE GIPA ACT contact the Information and Privacy Commission on 1800 472 679 or visit the IPC’s website at www.ipc.nsw.gov.au

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Have you applied, at any 
time, to the NSW RFS or 
If yes, please 
another agency for similar 
state the name of 
information?  Yes               No 
the agency
YOUR DETAILS
Mr 
  Ms 
  Other 
  
Name:
Surname:
Other names:
Postal address:
Postcode:
Email:
Day-time phone number:
Type of applicant:
Not For Profit or 
Media 
     Member of Parliament 
     Private sector business 
                               
Community Group 
Member of the public (application by legal representative) 
Member of the public (other) 
Why would you like to 
access this information?
Are you acting on behalf 
of another  person or 
Yes  
                 Name of person or party
party? 
No  
Are you seeking 
your own personal 
Yes  
                
information?
No  
The questions below are optional and the information will only be used for the purpose of providing better service.
Place of birth:
Main language 
spoken:
Aboriginal or 
Torres 
Torres Strait Islander:
Aboriginal 
Strait Islander 
Do you have special 
needs for assistance with 
this application?
PROOF OF IDENTITY
Only required when an applicant is requesting information on their own behalf.
When seeking access to your own personal information, an applicant should provide proof of identity in the form of a copy of 
any one of the following documents: 
   Australian driver’s licence (with photograph, signature and current address) 
   Current Australian passport 
   Other proof of signature and current address details 
Where an applicant is requesting personal information of a client, the applicant should provide a signed authority to act from the client.
GOVERNMENT INFORMATION (PUBLIC ACCESS) ACT 2009 - NSW FORMAL ACCESS APPLICATION
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FOR GENERAL INFORMATION ABOUT THE GIPA ACT contact the Information and Privacy Commission on 1800 472 679 or visit the IPC’s website at www.ipc.nsw.gov.au

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FORM OF ACCESS
You can only object to the inclusion of information on an 
agency’s disclosure log for one or more of the following 
How do you wish to access the information?
grounds:
   A copy of the document(s)  
   The information includes personal information about 
you (or a deceased person for whom you are the 
   Inspect the document(s)
personal representative)
   Access in another way (please specify)       
   The information concerns your business, commercial, 
professional or financial interests
   The information concerns research that has been, is 
being, or is intended to be, carried out by someone on 
your behalf
DISCLOSURE LOG 
   The information concerns the affairs of a government 
If the information sought is released to you and we consider 
of the Commonwealth or another State (and you are 
it may be of interest to other members of the public, details 
about your application may be recorded in the agency’s 
entitled to act on behalf of that government agency).
‘disclosure log’. This is published on our website. If you object 
to this, we must first decide if you are entitled to object and 
Do you object to this?   
if so, whether the objection outweighs the general public 
interest in including this information in the disclosure log. 
Yes 
    No 
PLEASE NOTE: if an agency decides to include information 
in its disclosure log despite your objection, you can seek a 
review of this decision.
APPLICATION FEE 
   Financial hardship – please attach supporting 
I attach payment of the $30 application fee by CHEQUE / 
documentation (e.g. a Pensioner or Centrelink card).
MONEY ORDER. 
AND / OR 
(Note: Cheques and money orders are to be made payable to 
the NSW Rural Fire Service)
   Special benefit to the public – please specify why:  
DISCOUNT IN PROCESSING CHARGES
You may be asked to pay a charge for processing the 
application ($30 per hour).
Some applicants may be entitled to a 50% reduction in their 
processing charges. If you wish to apply for a discount, please  PLEASE NOTE: that a processing charge cannot be 
indicate the reason: 
discounted by more than 50% even if both reasons are 
relevant.
  
Date:       /        /
Applicant’s signature:  
Please send this form to:
or lodge it at: 
NSW RURAL FIRE SERVICE
4 Murray Rose Avenue, Sydney Olympic Park
Attention: The Right to Information Officer
FOR GENERAL INFORMATION ABOUT THE GIPA ACT 
Locked Bag 17
contact the Information and Privacy Commission on 1800 
Granville NSW 2142 
472 679 or visit the IPC’s website at www.ipc.nsw.gov.au
GOVERNMENT INFORMATION (PUBLIC ACCESS) ACT 2009 - NSW FORMAL ACCESS APPLICATION
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FOR GENERAL INFORMATION ABOUT THE GIPA ACT contact the Information and Privacy Commission on 1800 472 679 or visit the IPC’s website at www.ipc.nsw.gov.au

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