FREEDOM OF INFORMATION ACT 1992
APPLICATION FOR ACCESS TO DOCUMENTS
________________________________________________________________________
Applicant Details
Surname:
_________________________________________
Given Name:
_________________________________________
Australian Contact Address:
_________________________________________
_____________________________________________________________________
___________________________________________ Postcode: _________________
Daytime Contact Number:
_________________________________________
Mobile:
_________________________________________
Your reference (if applicable):
_________________________________________
Agent/Representative’s Name and contact details (if applicable)
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Details of request (please tick the appropriate box and provide details)
Request for documents containing personal information only.
Request for documents including Non-Personal documents. This attracts
an application fee of $30 payable at the time of applying. Payments can
be made by cheque, made payable to DFES, or credit card.
Freedom of Information Application Form - DFES
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Please complete the following details if relevant to your request:
I am applying for access to documents concerning an incident:
Date of Incident:
_______________________________________________
Incident number (if known); _______________________________________________
Address or location of incident:
______________________________________________________________________
______________________________________________________________________
________________________________ Postcode: ____________________________
OR
I am applying for access to document(s) concerning:
Please describe clearly the documents you are requesting access to (include dates,
location, subject matter or any other information that would enable the requested
documents to be identified). Your reasons for access (
optional) may assist in the
accurate capture of documents:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
I understand that before I have access to documents I
may have to pay processing
charges and that in this case I will be supplied with a letter relating to the statement of
charges that would be incurred, prior to proceeding with the request.
Applicant’s Signature: ………………………………..
Date: …….../…..…. /……….
Freedom of Information Application Form - DFES
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Fees and Charges
DFES accepts payment by cheque or credit card only.
Payment by Cheque:
Please attach cheque to the application form to the
amount of $ 30.00 to cover the application fee.
Payment by Credit Card:
Please fill out the form below
MASTERCARD [ ] BANKCARD [ ] VISA [ ]
CARD NUMBER _ _ _ _ / _ _ _ _ / _ _ _ _ / _ _ _ _
CARD HOLDER'S NAME
_______________________________________________________________________
ADDRESS
_______________________________________________________________________
_______________________________________________________________________
CITY
___________________________________ POSTCODE ___________________
EXPIRY DATE _ _ / _ _ TOTAL AMOUNT ___________________
I authorise the Department of Fire and Emergency Services (DFES) to debit my credit
card with the amount shown above. I certify that I am over 18 years of age.
SIGNATURE __________________________________________________
Freedom of Information Application Form - DFES
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NOTES FOR APPLICANTS
FOI Applications
In some instances DFES may request proof of your identity.
Your application will be dealt with as soon as practicable (statutory maximum time
limit within 45 days) after it is received. However, where necessary, extensions may
be obtained.
If you are seeking access to a document(s) on behalf of another person, then DFES
may require written authorisation from the person you represent.
Further information can be obtained from DFES’s FOI Coordinator (Ph (08) 9395
9381). The
Freedom of Information Act 1992 may be purchased from the State Law
Publisher, 10 William Street, Perth Ph (08) 9321 7688 or by viewing the electronic
copy on the FOI Commissioner’s website:
www.foi.wa.gov.au.
Applications may be lodged (together with applicable fee or charge) in the following ways:
In person
FOI Coordinator Dept. Fire and Emergency Services
Emergency Services Complex
20 Stockton Bend
COCKBURN CENTRAL WA 6164
– OR –
By mail
FOI Coordinator
PO Box 1174
PERTH WA 6844
– OR –
By email
xxx@xxxx.xx.xxx.xx
Fees and Charges
The application fee is currently $30. If necessary, DFES may impose a charge for
processing the application.
Applications seeking personal information or amendment of personal information are
free of any fee or charge.
If charges apply DFES will send you a statement of payable charges. Currently,
where a processing charges applies, the current breakdown of fees is as follows:
Personal Information (about you personally)
Free (No application fee)
Non-Personal Information Only
$30.00 application fee
$30.00 p/hr of staff time processing charge (if number of pages is greater than 50)
$30.00 p/hr of staff time photocopying time (if number of pages is greater than 50)
$ 0.20 p/photocopy (if number of pages is greater than 50)
$0.60 per photograph
Freedom of Information Application Form - DFES
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