Informal Access Request Form

Section 8. Government Information (Public Access) Act 2009

About this form

ABOUT THIS FORM

This form is to be used for access and/or disclosure of documents held by the council within files or stored electronically on council’s records management system.

COPIES OF PLANS

If you seeking copies of plans, in particular, house plans, please submit a Plan Request.

YOUR PRIVACY

Copy charges may apply in accordance with Council’s adopted fees and charges. Please ask staff for further details. Port Stephens Council is committed to protecting your privacy. We take reasonable steps to comply with relevant legislation and Council policy.

Purpose: Public access to Council’s documents.

Intended recipients: Council staff and the form may be publicly available under the Government Information (Public Access) Act 2009.

Supply: Voluntary.

Consequence of Non Provision: Failure to complete the form may result in insufficient information being provided.

Storage and security: This document will be placed on the relevant file and/or saved in Council’s records management system in accordance with Council policy and relevant legislation.

Access: Please contact Council on (02) 4988 0255 to inquire how you can access information.

Form cannot be submitted until all field errors on this page have been fixed.

APPLICANT DETAILS

Are you applying as an individual or Company?: *

Individual
Company

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Title: *

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First Name: *

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Middle Name(s): *

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Surname: *

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Home Phone: *

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Mobile Number: *

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Contact name: *

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Company / Organisation Name: *

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ABN: *

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Office Number: *

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Fax: *

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Email Address: *

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APPLICANT'S PHYSICAL ADDRESS

Physical Address: *

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Physical Address Line 2: *

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Physical Address Line 3: *

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Suburb: *

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State: *

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Postcode: *

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Is the postal address different to the physical address?: *

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APPLICANT'S POSTAL ADDRESS

Postal Address: *

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Postal Address (Line 2): *

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Postal Address (Line 3): *

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Suburb: *

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State: *

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Postcode: *

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Do you agree to receive correspondence at the above email address?: * Please note that even if consent is provided, correspondence will be sent to the nominated email at Council’s discretion.

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Date: *

Invalid date.

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Invalid date.

Date:

today

Name:

User type:

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REQUESTED INFORMATION

Is the information about your personal information?: *

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In relation to enquiries regarding the Dividing Fences Act: * If you are seeking information relating to a third person, business or agency, please indicate whether you provide your consent for your information to be forwarded to the relevant third party for the purposes of this request.

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I require access to the following information: *

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Supporting Documentation: * (maximum 10 MB per file; limit 3 files)

Use the "Choose files" button (above) or drop files here to upload.

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File Name:

File Description:

Draw On Image:

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Document inspection/delivery details

I wish to inspect at files at Council’s Administration Building: *

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Please forward by: *

Email
Mail

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