Information Act
Section 156
Application to waive or reduce fees
Use this form if you want to apply for a reduction or waiver of fees. Lodge the
completed form with the organisation to which you made your access Application.
Your name and contact details:
Title (please circle): Ms / Mrs / Miss / Mr / Dr /
Postal Address:
First Name:____________________________________
Family Name:__________________________________
Phone: (B/H)_____________(A/H)_________________
Email:________________________________________ Fax:____________________________
Details of your access Application:
Name the Organisation where you lodged your Application:
Date of Application:
Reference number provided by organisation (if any):
Fee you want waived or reduced (tick applicable box/boxes)
q Application fee - $30
q Processing fee
To make a decision, the organisation must have regard to the circumstances of the
Application (including financial hardship of the applicant) and the objects of the Act. You
should provide as much information as you can to show that your Application is a special
case that justifies the organisation departing from its usual practice of requiring full
payment of Application and processing fees.
Financial circumstances.
Is your financial position one of the reasons you are applying for reduction or waiver?
(please circle)
YES NO If YES, you should
explain and give evidence of your financial position. For example, if you hold
a pension card, or qualify for some other social security benefit, you may want to provide proof of
that, eg, a photocopy of the card. (Attach another sheet of paper with more details if necessary.)
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CONTINUED OVER THE PAGE
Financial circumstances (continued)
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Other circumstances that justify waiver or reduction:
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Sign Here Date / /
NOTES
Privacy
The contact details requested will assist the organisation to deal with your Application. If you wish
to rely on financial hardship as a basis for waiver or reduction, it will be necessary for the decision-
maker to consider personal information about your finances. Other personal information may also
need to be considered in order to assess the other circumstances of the Application. If you want to
discuss privacy issues, you may contact the Information Officer within the organisation.
More information
For general information about access to NT Government information under the
Information Act you
may visit www.infocomm.nt.gov.au, or contact the Office of the Information Commissioner —
phone 1800 005 610 or 8999 1500, fax 8981 3812, email xxxxxxxx@xx.xxx.xx, or post PO Box
3750, Darwin NT 0801.
For help filling out this form, contact the Information Officer for the organisation that holds the
information you want (for details, contact the Government Switchboard on 8999 5511).
