Application for access to
Council information
Government Information (Public Access) Act 2009
Expiry Date: 30 June 2020
About this form
1. This form is to be used for access to information held by Council.
2. Council will provide access to information it holds except where there is a legal
Important Information: please read carefully
before completing your application
requirement exempting Council from releasing the document or where there is an
overriding public interest against disclosure of the information.
3. Council will not disclose the name, address or other personal information of members of
the community who report, in good faith, information to Council relating to actions of
others who may have acted contrary to laws and regulations.
4. Applications for access to information wil be assessed in accordance with the relevant
legislative requirements and procedures in Council’s Procedures Database.
5. Copying shall be either at Council at a charge or by private facility as approved by the
Council. In the case of the private facility the responsible Council officer shall make the
necessary arrangements to have the documents delivered to that facility. Copy charges
shall be paid by the applicant direct to the private facility.
Fees and charges
1. There is no application fee for informal requests for information under the
Government Information (Public Access) Act 2009. Fees may apply for Council
publications or for photocopying information.
2. There is a $30.00 application fee for formal applications under the Government
Information (Public Access) Act.
3. A processing charge of $30.00 per hour for formal applications under the
Government Information (Public Access) Act 2009 wil also apply if the information
requested does not relate to the applicants personal affairs. A 50% reduction in
processing fees may be granted for applicants claiming financial hardship or special
public benefit reasons when submitting an application.
Application details
I am submitting an
informal request for access to Council information (no application fee)
I am submitting a
formal application for access to Council information ($30.00 application fee)
Note: Council encourages applications for access to information to be made, in the first instance, under the informal
request provisions of the Government Information (Public Access) Act 2009.
Applicant’s details
Your name, address and
Title:
Mr
Mrs Miss
Ms
Other: .......................
contact details
Family name (or company): ............... ...............................................................
Given name(s): .................................................................................................
Postal Address: ................................................................................................
...................................................................... Postcode
……………………………. ...................................
Telephone (B) (….) ....................................... Fax (….) .....................................
Telephone (H) (….) ....................................... Mobile: .......................................
E-mail …………………………………………………………………………………….………..
Contact person (if a company): ……………………………………………….
Information requested
Details of information
I apply for access to the following information:
requested
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
If you are applying for
…………………………………………………………………………………………………………
access to property
…………………………………………………………………………………………………………
information, please provide If the information sought relates to a property please provide the address:
full address and DA, BA and …………………………………………………………………………………………………………
CC No’s if known.
The information relates to my personal affairs Yes No
I am the owner of the property Yes No
I act for the owner of the property Yes * No
Form of access applied for Inspection Copy
Proof of authorisation to act for the owner of the property is required before Council
wil permit access to any information that is not “Open Access” information under the
Government Information (Public Access) Act 2009.
Proof of authorisation can be written authorisation attached to this application or
completion of the fol owing Owner’s Consent declaration.
Owner’s Consent
As the owner(s) of the above property, I/we give consent to this application.
…………………………………….. …………………………….. ……………
Owner’s name Signature Date
Signature
1. Your Declaration
1. I agree to pay all required fees in accordance with Council’s adopted fees and
charges.
2. I declare that all the information given on this application form is true and correct.
3 I understand that I must seek the Copyright Owner’s consent in order to use any
part of a copyright document for any other purpose.
Signature: ..................................................... …Date: ......................................
Print Name: ......................................................................................................
How to lodge this application
Address the application The General Manager
Payment methods
to:
Woollahra Municipal Council
Payment can be made at our Customer Service Centre by
You can send it to us by any of the following methods:
the following methods: cash, EFTPOS, cheque or Money
Email:
xxxxxxx@xxxxxxxxx.xxx.xxx.xx
Order (make payable to Wool ahra Council) or by credit
Post:
PO Box 61
card — American Express, Bankcard, Diners Club,
Double Bay 1360
MasterCard or Visa.
Credit Card payment wil incur a processing fee.
DX:
DX 3607 Double Bay
Courier or personal
Council Chambers
delivery:
536 New South Head Rd
Double Bay NSW 2028
Contact us by phone, fax or electronical y
Phone:
(02) 9391 7000
Fax:
(02) 9391 7044
E-mail:
xxxxxxx@xxxxxxxxx.xxx.xxx.xx
www.wool ahra.nsw.gov.au
Web:
Privacy notification
The personal details requested on this form are being col ected, and wil only be used for, the purpose of processing
your application. The supply of information by you is voluntary. If you are unable to provide or do not wish to provide
the information sought, the Council may not be able to process your application. Access to the information is restricted
to Council officers and other authorised people. Council is to be regarded as the agency that holds the information. You
may make application for access or amendment to information held by Council. You may also request Council to
suppress your personal information from a public register.
To be completed by Council’s Cashier or Customer Service Officer.
OFFICE USE ONLY
GST may be applicable.
Retain your receipt as proof of lodgement of the application.
Fee Description
Fee Amt
Receipt Code
Receiving Officer: ......................... Date: ............
Government
Cashier: ....................................... Date: ............
Information (Public
$30.00
T17
Access) Act
Application Fee
Credit Card Payment Form
All credit card payment will incur a processing fee currently 1%
Payments should be sent to: Wool ahra Council
536 New South Head Road
DOUBLE BAY NSW 2028
OR
PO Box 61
DOUBLE BAY NSW 1360
OR
DX 3607 DOUBLE BAY
Credit card payment
Tick Applicable Credit Card AMERICAN EXPRESS
DINERS CLUB
MASTERCARD
VISA
This matter will not be
Full Name on Credit Card
processed until the credit
card payment has been
Credit Card No.
--
--
--
authorised
Card Expiry Date
--
Total Amount Paid $
Cardholder’s Signature
Date
Contact Phone No.
Reason for payment
Please indicate in this
Payment For .
section the reason for the
payment and any other
Council Reference Eg. DA No.etc .
applicable information.
Address (where applicable) )
PRIVACY NOTIFICATION The personal details requested on this form are being collected, and wil only be used for, the purpose of
processing your payment. The supply of information by you is voluntary. If you cannot provide or do not wish
to provide the information sought, the Council wil not be able to process your payment. Access to the
information is restricted to Council officers. Council is to be regarded as the agency that holds the information.
You may make application for access or amendment to information held by Council.
OFFICE USE ONLY
Payment Processed
Yes
No
Cashier
Date
Document Outline
