This is an HTML version of an attachment to the Freedom of Information request 'Prosecutions and Penalty outcomes under POCTAA for 2014 to 2018'.


 
 
 
 

Freedom of Information (FOI) 
Requesting access to RSPCA documents 
 
Name:  ____________________________________________________________________________________ 
 
Address:  __________________________________________________________________________________ 
 
Suburb:  _____________________________________________________   Post Code:   _________________ 
 
Telephone:  (BH)   ____________________________________  (AH)   ________________________________ 
 
 
Under the Freedom of Information Act 1982, I wish to gain access to the following document(s): 
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________ 
 
 
Please provide the information below (tick where appropriate) 
 
 
I request copies of the document(s) to be forwarded by email. 
 
I request copies of the document(s) to be forwarded by post. 
 
I request an inspection of the original document. 
 
I am prepared to inspect copies of the document(s) where providing the originals would interfere 
unreasonably with the operations of RSPCA Victoria. 
 
 
Signature:  _______________________________   Date:  ___________ 
 
 
I enclose an application fee of $28.90 (a fee payable according to the FOI Act) and understand that I will 
be supplied with a statement of further charges if appropriate. 
 
Please select your payment method: 
 
 
My money order or cheque is enclosed. 
 
My credit card details are below. 
 
  Card Type (please circle):      Visa      American Express        Diners          MasterCard     
 
Card Number:     ___  ___  ___  ___  /  ___ ___ ___ ___  /  ___ ___ ___ ___  /  ___ ___ ___ ___ 
 
Expiry Date: __ __   / __ __ 
         
 
Name on Card:  _________________________________ 
 
Signature:  _____________________________________ 
 
 
Return this form to: 
Freedom of Information Officer 
RSPCA (Victoria) 
3 Burwood Hwy 
Burwood East  VIC  3151 
 
or by email to [RSPCA Victoria request email] 
 
 
(Staff use only) Application Fee Received:   ________________________________  Receipt No. __________________ 

The Royal Society for the Prevention of Cruelty to Animals (Victoria)  
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