INFORMAL ACCESS REQUEST FORM
THIS FORM IS TO BE USED WHEN REQUESTING OPEN ACCESS INFORMATION HELD BY
COUNCIL IN ACCORDANCE WITH SECTION 8 OF THE GOVERNMENT INFORMATION (PUBLIC
ACCESS) ACT 2009 & SCHEDULE 5 - GOVERNMENT INFORMATION (PUBLIC ACCESS)
REGULATION 2009
PO Box 21 Gosford 2250
Phone 4325 8222 Email
xxxxxxx@xxxxxxx.xxx.xxx.xx
APPLICANT'S DETAILS
Surname……………………………Given names…………………………Title (Mr/Mrs/Ms)…………..
Email…………………………………………………………………………………………………………..
Postal Address……………………………………………………………………………………………….
………………………………………………….State…………………Postcode………………………….
Telephone Number (H)………..…………..(W)………………….………(M)…………………………….
Is the information about your personal information? [ ] Yes [ ] No
Personal Information means information or an opinion (including information or an opinion
forming part of a database and whether or not recorded in a material form) about an individual
(whether living or deceased) whose identity is apparent or can be reasonably be ascertained from
the information or opinion.
DETAILS OF INFORMATION REQUIRED: Please describe the information you would like
to access in enough detail to assist us with identification.
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
…………………………………………………………………………………………………………..
PROPERTY DETAILS (if applicable)
Street Address……………………………………………………………………………………………….
Lot No……….…..DP/SP No…………………Development Application No (if known)……………….
01/07/10
PLEASE NOTE: OWNER'S WRITTEN CONSENT REQUIRED FOR FLOOR PLANS.
COPYING CHARGES
Copy charges apply in accordance with Council's adopted fees and charges (available on our
website)
Applicant advised of estimated copying charges of $...........
[ ] Yes [ ] No [ ] Not required (Please tick applicable)
DOCUMENT PROVISION DETAILS
In the interests of the environment and as is consistent with Council's Environment Policy, this
information wil be provided electronical y, therefore please ensure you have provided an email
address. An alternative method of provision may be considered.
COPYRIGHT NOTICE:
Council may provide the applicant with a copy of a document for information
purposes only, as required by relevant legislation. Copyright laws, in accordance with
the Copyright Act 1968, stil apply to that document.
I, the undersigned, understand the following:
1. Should the documents requested not be held in Council's electronic recordkeeping
system, I may be required to submit a Formal Access Application.
2. Owner's written consent
must be provided to obtain copies of floor plans.
3. Council will undertake a reasonable search of its records to satisfy requests in
accordance with Section 8 and Section 53 GIPAA.
4. The copyright-owner's consent is required if any part of the document is used for any
other purpose.
5. Historical records held on microfiche may not be of a printable quality.
6. Council will endeavour to meet these requests within a 15 day period having regard to
circumstances of the case and availability of staff
Signature……………………………………………………………..Date…………………………
If you require assistance in completing this form, please contact Customer Services on
(02) 4325 8222 or visit our website a
t www.gosford.nsw.gov.au
01/07/10
