Application for City of Darwin Information.pdf

APPLICATION FOR COUNCIL INFORMATION
Under the Information Act (NT) 2002

APPLICANT DETAILS
Preferred title: Mr/Mrs/Miss/Ms/Other
Surname: _______________________________ First Name(s): ____________________________________
Address for correspondence: ________________________________________________________________
                                   ________________________________________________________________
Email Address: ___________________________________________________________________________
Contact numbers: A/H:   _____________________________ Mobile: ________________________________
                  B/H:  _____________________________ Fax:     _________________________________
Preferred method of contact:
Telephone
Facsimile
Email
Mail

Privacy Statement: The Information Act (NT) 2002 (the Act) requires you to supply your name and an
address for correspondence. Additional contact details will assist the City of Darwin to deal with your
application. Personal information supplied in the course of an application may be used or disclosed in the
consultation process to make an informed decision on the application and any review or complaint arising from
the application.

ARE YOU MAKING THIS REQUEST ON BEHALF OF ANOTHER PERSON?
Yes
No
Name of other person:______________________________________________________________________
In which capacity do you act on behalf of the other person :________________________________________
Proof of capacity must be attached

ARE YOU MAKING THIS REQUEST ON BEHALF OF AN ORGANISATION?
Yes
No
Name of organisation/business: ______________________________________________________________
Your position/office in the organisation: ________________________________________________________
Proof of position must be attached

IF YOU ARE PREVENTED BY A DISABILITY TO ACCESS THE DOCUMENTS PLEASE
INDICATE IN WHICH FORMAT YOU REQUIRE ACCESS

Disability
Format

HOW DO YOU WANT ACCESSS TO THE DOCUMENTS?
             I want to inspect the document(s)
                          I want a copy of the document(s)


PLEASE TAKE NOTE OF THE FOLLOWING
Compliance with your request for access in a specific format may  depend on the format of the original
documents and the viability to translate or change to the format required.  In such a case you will be  notified
of the format in which the documents can be provided.

Application for Council Information – Last updated 28/08/2012
Page 1

INFORMATION SOUGHT
Please provide as much detail as you can about the type of information you want, eg. dates, location, subject
matter, who was involved. If insufficient space please attach a separate sheet of paper.
FEES AND CHARGES
Attached is a cheque/money order/credit card details (please circle) to the amount of $30 to cover the
application fee. ( Please do not send cash through the mail, pay at Customer Service Counter).  If a
processing fee is required, you may be asked to pay a deposit of $25 if the processing fee is estimated to be
$100 or less, or 50% of the estimate if the processing fee is estimated to be more than $100. You will be
notified if a processing fee is required.  Application can be made to waive/reduce fees. There are no fees for
an application for personal information.
DECLARATION
I understand that before I obtain access to information I may be required to pay processing fees equal to the
total cost of the services and material that are provided in response to this application and that I will be
supplied with a statement of charges if appropriate. I certify that the information supplied by me concerning
this application is complete and true to the best of my knowledge.  I have read and understood the Privacy
Statement on page 1. (Council’s Privacy Policy can be found on the City of Darwin official website at
http://www.darwin.nt.gov.au).
Signature: __________________________________________________ Date: ________________
OFFICE USE ONLY
Receipt No: ______________________________________Reference No: __________________________
Application Receipt Date:__________________________
Satisfied as to Identity of Applicant:  Yes     No
Receiving Officer’s Name and Title: (please print) _____________________________________________
Signature of Receiving Officer:_____________________________________________________________
Application for Council Information – Last updated 28/08/2012
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NOTES ABOUT DARWIN CITY COUNCIL INFORMATION FORM

1.  Identification
You will be asked to show identification when lodging this application.  If posting your application, please
attach a photocopy of your driver’s license, passport or another form of approved identification documentation.
This is to ensure that Council is satisfied as to your identity.

2.  Where to lodge this application
This application can be lodged at the Civic Centre in Harry Chan Avenue, Darwin or posted to the Information
Officer, City of Darwin, GPO Box 84 DARWIN, NT, 0801.

3.  Processing your application
  The Council will respond in writing to your request within 30 days of receiving your application.
  Should it be necessary to view records you will be contacted regarding a suitable time and venue.
  If aggrieved by the decision, you may apply for an internal review to which the Council has 30 days to
respond.  If unsatisfied with the review outcome you may lodge a complaint with the Information
Commissioner within 90 days (s.106 (3) (a) of the Act).

4.  Decisions in relation to applications
The response to this application could inform you that the Council will:
  provide access in whole or part;
  provide edited copies of the information;
  defer access;
  refuse access because the information is exempt under the Act;
  refuse access because providing access would unreasonably interfere with the operations of the Council;
or;
  require more time to make a decision.

(Refer to sections 21-30 of the Act)

EXEMPTIONS
The Council is not required to provide access to information classified as exempt under the Act.  These
exemptions are:
1. Part 4, Division 2 sections 45-49
  Executive Council, Cabinet, Territory economy;
  Information that would prejudice security or law enforcement;
  Information that is exempt under corresponding FOI laws;
  Information subject to a secrecy provision; and
  Information that would prejudice the preservation of our system of justice.
2. Part 4, Division 3 sections 50-58
  Particular case matters where disclosure may not be in the public interest.

ASSISTANCE
If you need help to complete this application form please contact the Information Officer, City of Darwin, GPO
Box 84, Darwin NT 0801, Phone: (08) 8930 0300, Facsimile: (08) 8930 0311 or Email:
xxxxxx@xxxxxx.xx.xxx.xx.

Further information about the Information Act can be found at www.darwin.nt.gov.au

Application for Council Information – Last updated 28/08/2012
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