H a w k e s b u r y C i t y C o u n c i l
366 George Street (PO Box 146) Windsor NSW 2756
DX 8601 WINDSOR
Phone: (02) 4560 4444
Facsimile: (02) 4587 7740
Email: xxxxxxx@xxxxxxxxxx.xxx.xxx.xx
Informal Access Request Form
Government Information (Public Access) Act 2009 and
Government Information (Public Access) Regulation 2009
(No application fee payable, processing charges may apply)
Applicant Details
Title (Mr/Mrs/Ms)
Name
Surname
Company Name
Address
Postal Address
Telephone
Mobile Phone
Email
Application Details
Please provide as much information about your request as possible. I request access to
information/documents(s).
If you require development information and you are not the owner, some documents may not be viewed and
copied e.g. internal floor plans, unless the owner's consent is provided (see over).
If the information is about a property, please complete the following.
Lot No.
DP/SP No.
DA No.
Property Address
Age of Building
Time Period: (please tick)
Pre 1991
1991-2002
Post 2002
Other Considerations
Please advise us
WHY you would like this information, as it may assist us in determining the release of
information sought, and applying the public interest test.
H a w k e s b u r y C i t y C o u n c i l
Form of Access (please tick)
I wish to inspect the document(s)
Yes
No
I require a copy of the document(s)
Yes
No
I require access in another form
Yes*
No
*Please Specify
Declaration
1.
I understand that I may be required to pay charges in accordance with Council’s Operational Plan
(fees and charges) in respect of this request.
2.
I undertake that I will not remove, alter, deface or destroy any items contained within the files to which
I have been granted access under this request.
3.
In accordance with copyright laws, I undertake to refrain from copying, photographing, scanning or
reproducing any images of documents provided to me for viewing purposes.
4.
Should I be provided with copies of DA Documents under Clause 268 of the regulations, I note
copyright laws still apply.
I (Applicant's Name)
Applicant's Signature
Date
Owner's Consent (if applicable)
1.
I confirm that I am the owner of the property, which is the subject of this application.
2.
I consent to the applicant being provided access to and/or copies of all information requested on this
application.
I (Owner's Name)
Owner's Signature
Date
Office Use Only
Copy Fee
Receipt number
Privacy Notice
Council is bound by the provisions of the Privacy and Personal Information Protection Act 1998, in the collection, storage and utilisation of
personal information provided in this form. Accordingly, the personal information will only be utilised for the purposes for which it has been
obtained and may be available for public access and/or disclosure under various NSW Government legislation.
May 2016