FREEDOM OF INFORMATION APPLICATION FORM
This form is to be used when making an application to the City of Darebin under the Victorian Freedom of
Information Act (1982).
Please complete this form and send it to:
Freedom of Information Officer
City of Darebin
PO Box 91, PRESTON VIC 3072
Email: xxx@xxxxxxx.xxx.xxx.xx
1.
Applicants Contact Details
Title (Mr / Mrs / Ms / Miss) ……………………………………
Name: .......................................................................................................…………………………
Organisation: ......................................................................................................…………………
Postal Address ……….......................................................................................................……….
Suburb: ........................................................................................................ Postcode.................
Phone Contact No: (Daytime)..........................................…Email…...........................................
2.
Documents sought
I seek access to the following document(s):
3.
Section 33(3): Document affecting personal privacy
The FOI Act prescribes a process of notification and consultation that I must follow in accordance with Section 33(3)
before any documents containing personal affairs information may be released. While I would ordinarily have an
obligation under the FOI Act to make a decision within 30 days from the date upon which your valid application was
received, the process of consultation might result in an extension of 15 days.
However, where an applicant indicates that they do not seek access to personal affairs information as that
information is not sought, and they are happy to receive documents with personal affairs information deleted the
processing of your application is likely to be expedited and potentially increase the amount of other information that
might be available.
Please indicate below by way of
Yes/No if personal affairs information is relevant to your needs. (If
No, personal
information will be deleted from any documents released)
Yes
No
4.
Form of access
Please indicate if you would like to inspect or receive a copy of the documents:
I would like to inspect the document(s) at the Council Offices
Or
I would like a copy of the document(s) sent to me
5.
Fees and Charges – (effective 1 July 2021)
Where the payment of fees or charges may cause financial hardship, an applicant may apply for a reduction or
waiver. If you wish to request consideration for a reduction or waiver, please state the reasons for your request and
attach documentary evidence such as a photocopy of your Commonwealth Pension or Commonwealth Health Card.
A
$30.10 application fee either by
cheque or money order applies to requests for access to documents under the
FOI Act and should be attached to this form. Alternatively, you can pay your fee via
cash at any of our Customer
Service Centre’s during business hours. The Council may charge access costs as stipulated below.
▪
Search & retrieval charges - $22.50 per hour or part of an hour;
▪
Supervision charges - $22.50 per hour to be calculated per quarter hour;
▪
Photocopying charges;
• A0 = $3.20 – (per colour or black & white page)
• A1 = $1.60 – (per colour or black & white page)
• A2 = 80 cents – (per colour or black & white page)
• A3 = 40 cents – (per colour or black & white page)
• A4 = 20 cents – (per colour or black & white page)
(
Please note that copies of plans may not be able to be provided due to copyright restrictions).
Signature……………………………………………………………. Date………………………………………………
“The personal information collected on this form by the City of Darebin will only be used to assist in the processing of your request in
accordance with the Freedom of Information Act 1982. If you do not provide all or part of the personal information required, we may not be able
to process your request in an effective and efficient manner. Your personal information will not be disclosed to any external party without your
consent, unless required or authorised by law, and you have the right to seek access and correction of your personal information”.