Freedom of Information 
CP1-6-001 
PO Box 7910 
CANBERRA BC   ACT   2610 
Tel: 02 626 62200 
 
Fax: 02 626 62112 
xxx@xxxxxxx.xxx.xx 
 
FREEDOM OF INFORMATION REQUEST - PAYMENT AUTHORISATION 
 
 
FULL NAME or ORGANISATION 
 
Service or PMKEYS ID (if applicable) 
POSTAL ADDRESS: 
 
CONTACT PHONE NUMBERS 
H/B 
 
 M 
 
EMAIL: 
 
FOI REFERENCE : 
 
DEPOSIT AMOUNT $  
$76.25 
 
By signing this form you are agreeing to pay the charges notified to you by the Freedom of 
Information Directorate. Once you have signed this form the charges are considered imposed. 
The deposit is not refundable except in some limited circumstances (for example, if Defence 
fails to make a decision on your request within the statutory time limit), or may be refundable 
in part if the final charge is less than the deposit paid: 
On completion of your request a final invoice will be generated for the outstanding balance of 
charges. 
PLEASE DO NOT SEND CHEQUES OR MONEY ORDERS TO FOI  
Once our office receives this form, the Department of Defence will generate an invoice in 
order for you to make payment of the agreed charges via one of the payment options made 
available. 
The FOI Directorate will not proceed to process your request until a receipt has been 
received in our office notifying that the deposit amount has been paid. 
Please sign below and return this form by one of the following: 
 
via email to xxx@xxxxxxx.xxx.xx  
via fax 02 6266 2112 
by post to the address noted above. 
 
 
 
 
 
Signature: ____________________________________________________ 

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