Sensitive
NSW POLICE FORCE
Access Application
Government Information (Public Access) Act 2009
THE INFORMATION YOU ARE SEEKING MAY ALREADY BE AVAILABLE TO YOU
Details concerning decisions made by NSW Police Force (NSWPF) in response to an application made pursuant
to th
e Government Information (Public Access) Act 2009 (GIPA Act),
that may be of interest to other members of
the public, may be included on a Disclosure Log. The NSW Police Force's Disclosure Log provides details of:
The date the application was decided;
A description of the information to which access was provided;
A statement as to whether the information is now available to other members of the public and
How the information can be accessed.
Consultation will occur with an applicant prior to information being placed in the Disclosure Log.
Click
here to access NSW Police Force (NSWPF) disclosure logs or visit:
https
://www.police.nsw.gov.au/online_services/requesting_information/disclosure_logs
DO YOU NEED INFORMATION RELEVANT TO AN INSURANCE CLAIM?
If you are seeking a copy of a motor vehicle collision or crime incident report (event only) that you have reported
for insurance purposes, this information can be obtained through the NSWPF Insurance Services Unit. Visit:
https://www.police.nsw.gov.au/?a=481648
PUBLIC INTEREST CONSIDERATION MEAN THAT SOME INFORMATION MAY NOT BE MADE
AVAILABLE TO AN APPLICANT
The full list of public interest considerations against disclosure can be found within the GIPA Act, PART 2,
DIVISION 2, S
ECTION 14 (click here to view). Some of the most common public interest considerations
against disclosure of information are listed below.
Where the information would:
reveal an individual’s personal information,
contravene an information protection principle under the Privacy and Personal Information Protection Act
1998 or a Health Privacy Principle under the Health Records and Information Privacy Act 2002,
prejudice any court proceedings by revealing matter prepared for the purposes of or in relation to current or
future proceedings,
prejudice the fair trial of any person, the impartial adjudication of any case or a person’s right to procedural
fairness,
reveal false or unsubstantiated allegations about a person that are defamatory,
expose a person to a risk of harm or of serious harassment or serious intimidation,
in the case of the disclosure of personal information about a child—the disclosure of information that it would
not be in the best interests of the child to have disclosed,
prejudice the prevention, detection or investigation of a contravention or possible contravention of the law or
prejudice the enforcement of the law.
CORONIAL MATTERS
If the information you require relates to a deceased person/s whose death was investigated by the State
Coroner, please contact the Coroner's Office before completing this application, on telephone no. (02) 8584
7777, or visit the State Coroner
www.coroners.justice.nsw.gov.au (as information in relation to Coronial matters
can only be released by the Coroner’s office).
INSTRUCTIONS FOR COMPLETING YOUR APPLICATION
Please complete this form to apply for access to information held by the NSWPF pursuant to the GIPA Act.
Please mark the relevant boxes with a tick.
If you require your personal information, you MUST provide a copy of your Proof of Identity
If you are making this application on behalf of another person, you MUST ensure that person completes the
‘Authorisation’ section of this form or attach a separate authorisation
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Sensitive
NSW POLICE FORCE
Access Application
Government Information (Public Access) Act 2009
SECTION 1 : APPLICANT
Are you applying as an Individual or Business?
INDIVIDUAL
BUSINESS
Title
Company Name
First and Other Name(
s)
Company ABN
Last Name
Your Reference Number
Previous / Other First Name(
s)
(if applicable)
Your Title
Previous / Maiden Last Name(
s)
(if applicable)
Your First and Other Name(s)
Date of Birth (if this application for yourself)
Your Last Name
Are you or the business acting on behalf of another person / party? If so, what is the name of person / party?
Contact Details
Unit No / Street / Street Name
Residential
Suburb / Town / Locality
or
Business
Address
Postcode
State / Territory
Country
Same as Residential or Business Address, or
Unit No / Street / Street Name / PO Box
Postal
Suburb / Town / Locality
Address
Postcode
State / Territory
Country
Email
Address
Contact
Preferred
Alternate
Number
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NSW POLICE FORCE
Access Application
Government Information (Public Access) Act 2009
SECTION 2 : INFORMATION REQUESTED
What information are you requesting?
Criminal History
My criminal history
Criminal history of other person(
s)
Please provide details of information in ‘Information Description’ section below
Event Report(
s)
Where you are requesting information for multiple events, please supply information for each Event separately in
the ‘Information Description’ section below
Event Number
Date of incident (if known)
Where / Who incident reported to (if known)
e.g. Officer Name / Police Area Command / Police Assistance Line / Other)
Involved party / parties (if known)
Event Report(
s)
and related information
Please provide the event number(s) and specific information you are seeking, in the ‘Information Description’
section below
Information Description
Describe the information you would like to access in enough detail to enable reasonable searches to be conducted,
e.g. car registration number, date of birth, location, Event numbers, other person(s) names, phone numbers, etc.
If your application is unclear as to the information you require, or you do not provide sufficient information, your
application may be deemed invalid.
Attach additional pages (if necessary) with any additional information that you feel will support your application.
PLEASE NOTE THAT PURSUANT TO SECTION 75 OF THE GIPA ACT,
THE NSW POLICE FORCE IS NOT REQUIRED TO CREATE A NEW DOCUMENT TO RESPOND TO YOUR APPLICATION.
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NSW POLICE FORCE
Access Application
Government Information (Public Access) Act 2009
SECTION 3 : AUTHORISATION TO OBTAIN INFORMATION ABOUT THE PERSON THE INFORMATION RELATES TO
SECTION 3 MUST BE COMPLETED BY THE PERSON THE INFORMATION RELATES TO – OR ATTACHED SEPARATELY
I authorise the NSW Police Force to release information about me in matters relating to this
access application, to the Person / Legal Representative / Company / Agency named in Section 1
Full Name
Date of Birth
Address
Signature
Date
SECTION 4 : PROOF OF IDENTITY - INVOLVED PARTY
If seeking access to personal information, you MUST provide copy of one of the following documents to
confirm the identity of the involved party
Australian Drivers Licence
Current Australian Passport
Other proof of identity (e.g. Government issued identity or proof of age card)
Please note: Information may not be able to be released if identification requirements are not fulfilled
SECTION 5 : APPLICATION FEE PAYMENT
I attach the $30.00 application fee by the following payment method (Do NOT send cash)
Cheque
Cheques and Money Orders should be made payable to the
NSW Police Force
Money Order
Credit Card
Complet
ed Credit Card Payment Form MUST be attached
Please note: An Access Application cannot be deemed valid without receipt of the application fee of $30.00
SECTION 6 : PROCESSING CHARGES
A processing charge of $30.00 per hour may be applied pursuant to Section 64 of the GIPA Act. You will be notified
prior, if processing charges apply. Some applicants may be entitled to a 50% reduction in their processing charges.
Further information about this will be advised at the time of notification of additional processing charges.
Where information requested is considered ‘non‐personal’ additional charges will apply – you will be notified should
this apply to your application.
SECTION 7 : FORM OF ACCESS
Where information is located and able to be released, how do you wish to access this information?
A copy of the document(s)
Inspect the document(s)
Access in another way (please specify)
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NSW POLICE FORCE
Access Application
Government Information (Public Access) Act 2009
SECTION 8 : CONSULTATION
The GIPA Act requires an agency to consult with third parties when considering the potential release of other
person(s) information (pursuant to Section 54 of the GIPA Act).
Where consultation with a third party is required, the time to respond to your application will be extended by 10
working days.
Where another person’s details are contained within the information you are requesting, do you wish for
those persons to be contacted to obtain their consent to release their information to you?
(If you do not consent to our agency consulting with involved persons, their information may not be released to you).
Yes
No
When consulting, do you agree for this agency to provide your details as the ‘applicant’ to the other party
and/or a third party?
(If you do not consent to our agency providing these details, this may impact on the consulted agency’s/third party’s decision to release information).
Yes, I agree
No, I DO NOT agree
SECTION 9 : PRIVACY STATEMENT
The NSWPF is subject to the
Privacy and Personal Information Protection Act 1998 and the
Health Records and
Information Privacy Act 2002 which require this agency to comply with Information and Health Privacy Principles.
Your personal information is being collected to process your application for information. The NSWPF may use your
personal information for the purposes of processing your application within the agency.
The NSWPF is required to collect personal information directly from the individual unless the individual has authorised
collection of the information from someone else. The NSWPF will not disclose your personal information without your
consent unless authorised by law.
Your personal information will be held by NSWPF at 1 Charles Street, Parramatta NSW 2150. You have the right to
access and correct the information if you believe that it is incorrect.
SECTION 10 : APPLICANT’S SIGNATURE
Applicant’s Signature
Date
SECTION 11 : APPLICATION LODGEMENT OPTIONS
NSW Police Force, InfoLink Unit
Phone: 02 8835 6888
Monday to Friday between 08.30am and 4.30pm
xxxxxxx@xxxxxx.xxx.xxx.xx
Via Email
A credit card authority must accompany any emailed application
Save Form
NSW Police Force, InfoLink Unit,
Via Post
Print Form
Locked Bag 5102, Parramatta NSW 2124
APPLICANT CHECKLIST
Completed all pages of the application form
Enclosed payment
Provided proof of identity (personal applications)
Completed Authorisation Section (where applicable)
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