Ma
M nly
a
C
nly
ounc
C
il
ounc
GENERAL Information Access
Council Of
C
f
ouncil Of i
f ces 1 Be
ces 1 B lgrave
v Street
St
reet M
a
M nly
PO Bo
PO B x
o 82 MA
82 M N
A L
N Y
L
NS
N W 1655
DX
D 9205 Ma
9205 M nl
n ywww.
y
manl
n y.
y ns
n w.go
g v
o .
v au
Request Form
Phone 02 9976
Phone 02
1500
9976
Fax 02 9976 1400
Fax 02 9976
Email:
Email: records
o
@ma
@
nly.
nly nsw.gov.a
gov u
Please complete this form to apply for access to Council information
under the Government Information (Public Access) Act 2009 (GIPA Act).
ABN 43 662 868 065
Applicant Details
Information will
Name/Company
be available
within 20
working
days unless
Postal Address
extended (where
necessary)
Suburb
Postcode
Telephone
Email
I agree to recieve correspondence at the above email address
Council reserves
the right to decide
the conditions and
Signature
Date
means by which
access to
information will
be provided
Property Details
Lot No.
Parcel No.
DP/SP No.
Fees ‐ If
photocopying,
charges apply.
Street No.
Street name
Refer to Councils
Fees & Charges
p28.
Suburb
Postcode
Details of Information requested
Describe the
information you
wish to access in
enough detail for
us to identify it.
Insufficient detail
may result in a
delays.
For further information
information visit:
visit: www.manly.nsw.gov.au
www.manly.nsw.gov.au or phone
phone 9976
9976 1500
Reason for information request
*Optional. Helps
identify
other/alternate
information
relevant to your
request.
Proof of Identity
Requests for
personal
Do you seek access to your own personal information?
Yes
No
information other
than your own,
If yes, please indicate what proof of your identification (certified copy) you have attached to this request:
may not be in the
public interest. If
Current Australian driver's licence; or
so, you will be
notified and given
Current Australian passport; or
an opportunity to
Current Australian Credit Card
lodge a formal
application ‐ fees
Other, please specify
apply.
You acknowledge copies of documents are provided to for information only and that you must obtain the copyright
owner's consent if used for any other purpose.
Signature
Date
Information removed (Office use only)
If you are dissatisfied with Councils decision to withhold informaiton you may wish to lodge a formal application or
contact the Office of the Information Commissioner on 1800 463 626.
Office use only
Date received
Form of Access (to be completed when information supplied)
Officer
Applicants signature
Date
In person
Date processed
Form/Method
Date
Electronically
Charges (
$)
Form/Method
Date
Other
Officer
CS-1A - December 2010
For further information
information visit:
visit: www.manly.nsw.gov.au
www.manly.nsw.gov.au or phone
phone 9976
9976 1500