Freedom of Information Application Form
NAME: ______________________________________________________________
POSTAL ADDRESS: __________________________________________________
____________________________________________________________________
TELEPHONE CONTACT: BH: _______________
AH: _____________________
DETAILS OF DOCUMENTS REQUESTED
Please clearly identify the documents sought. Include dates, times, places, location of
incident (s). ___________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
FORM OF ACCESS REQUIRED: (
Tick one)
□
(a) A copy of the document(s)
□
(b) Inspection of the document(s)
(c) Access in another form (specify)
□
I understand that an application fee of $27.90 must accompany this request and that further
reasonable charges for photocopying and other processing costs may be applicable. FOI
fees and charges are not subject to GST.
Signature: __________________________________
Date: ______________________
Send request and cheque/money order (payable to VicRoads) for $27.90 to:
Manager, Freedom of Information and Information Privacy
5th Floor
60 Denmark Street
KEW VIC 3101
Document Outline
