Government Information (Public Access) Act 2009 - ACCESS APPLICATION
Please complete this form to apply for formal access to government information under the
Government
Information (Public Access) Act 2009 (
GIPA Act). If you need help in filling out this form, please contact the GIPA
Officer on (02) 8849 6229 or visit our website at www.sydneywater.com.au
1.
Your details
Name: Mr / Mrs /Ms ..............................................................................................................................
Postal address:
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Postcode: ………….............
Day-time telephone:
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Email (optional): ..........…...................................................
2.
Proof of identity
Are you seeking personal information? Yes No
When seeking access to personal information, an applicant must provide proof of identity in the form of a certified
copy of any one of the following documents:
Australian driver’s licence
Current Australian passport
Other proof with photograph, signature and current address
3.
Government information
Please describe the information you would like to access in enough detail to allow us to identify it.
Note: If you do not give enough details about the information, Sydney Water may refuse to process your application.
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Information request period: From (Date) …….………..……………………….. to (Date) …...…………………..………………….
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Government Information (Public Access) Act 2009
ACCESS APPLICATION FORM
4.
Form of access
How do you wish to access the information?
Inspect the document(s)
A copy of the document(s)
Access in another way (please specify)......................................................................................
5.
Application Fee
I attach payment of the
$30 application fee by cheque / money order payable to Sydney Water.
6.
Disclosure log
If the information sought is released to you and would be of interest to other members of the public,
details about your application may be recorded in Sydney Water’s ‘disclosure log’. This is published on
Sydney Water’s website.
Do you object to this?
Yes No
7.
Discount in processing charges
If you are given access to the information sought, you may be asked to pay a charge for processing the
application ($30 / hour). Some applicants may be entitled to a 50% reduction in their processing charges.
If you wish to apply for a discount, please indicate the reason:
Financial hardship – please attach supporting documentation (eg a copy of pension or Centrelink
card).
AND / OR
Special benefit to the public – please specify why below:
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Applicant’s signature: .........................................................................
Date: .................................................................................................
Please post this form to:
Government Information (Public Access) Officer
Sydney Water
PO Box 399
PARRAMATTA NSW 2124
General information about the GIPA Act is available by calling the Information and Privacy Commission on freecall
1800 472 679 or at its website: http://www.ipc.nsw.gov.au
Office use only
Date application received: ................................................................................
File reference: ...................................................................................................
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