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.
We could finalize your application quicker if you agree to have third party personal and/or
prescribed details (including names, position titles, addresses, telephone numbers, email
addresses and signature) deleted from the FOI documents as this may eliminate the legal
requirement to undertake third party consultations.
I consent to the removal of Third-Party personal information.
I consent to the removal of ‘prescribed details’ of agency officers.
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 require the documents in the following format:
Hardcopy
Electronic
Your E-mail address:
Both
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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