This is an HTML version of an attachment to the Freedom of Information request 'AIS scheme auditors'.

Credit Card Payments for Access Applications
Government  Information (Public Access) Act  2009
Applicant Details
Given name(s):
Business name:
Daytime contact phone number:
If this is an application for an internal review please add the Access Application Number:
Payment Type
Please indicate the reason for making this payment. (Tick the appropriate box)
Formal application:
Internal review:
Advance deposit - 50% initial payment:
Advance deposit - Final payment:
Credit Card Authority
Please debit my credit card the amount of $
Card type:
Card number
Cardholder's name
Expiry date
Cardholder Signature
TfNSW  is  collecting  this  information  so  that  we  can  process  the  fees  for  your  GIPA  application  or  internal  review 
request.  We  will  process  the  request  using  a  secure  interface  with  Westpac  Banking  Corporation,  and  will  not 
disclose the information to any other third party. We will hold the information for 30 working days in case we need to 
issue a refund (refunds can take up to 10 working days), after which we will destroy the information. The information 
will be held securely at 18 Lee Street Chippendale 2008.
Credit Card Payments for GIPA Access Applications  - Form No. 5323 (September 2015)