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Formal Access Application Form

Government Information (Public Access) Act 2009

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ABOUT THIS FORM

ABOUT THIS FORM

Please complete this form to apply for formal access to government information under the Government Information (Public Access) Act 2009 (GIPA Act). If you need help in filling out this form, please contact the Right to Information Officer on (02) 4980 0255 or visit our website at www.portstephens.nsw.gov.au

General information about the GIPA Act is available by calling the NSW Information & Privacy Commission on free call 1800 472 679 or at its website: www.ipc.nsw.gov.au

FEES AND CHARGES

You may be asked to pay a charge for processing the application ($30 / hour).

Some applicants may be entitled to a 50% reduction in their processing charges due to Financial hardship or Financial hardship. 

Please reference Councils prescribed schedule of Fees and Charges for further information. 

YOUR PRIVACY

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 is publicly available under the Government Information Public Access Act 2009.

Supply: Voluntary

Consequence of Non Provision: Insufficient information will be 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) 4980 0255 to enquire how you can access information.

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APPLICANT DETAILS

Are you applying as an individual or Company?: *

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APPLICANT'S PHYSICAL ADDRESS

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

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APPLICANT'S POSTAL ADDRESS

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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:
Date:
today
Name:
User type:

ADDITIONAL DETAILS

The questions below are optional and the information will only be used for the purposes of providing better service.

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Aboriginal or Torres Strait Islander: *

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THIRD PARTY CONSULTATION

Please indicate whether you consent to your identity as an applicant being disclosed to the involved third party: * Under section 54 of the GIPA Act, if the information you are requesting contains information about another person, business or agency, Council may be required to consult with third parties before deciding your application. The purpose of this consultation is for Council to determine whether the third party has an objection to disclosure of some or all of the information being requested

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GOVERNANCE INFORMATION

Note: If you do not give enough details about the information, the agency may refuse to process your application.

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PROOF OF IDENTITY

Are you requesting access to your personal information?: *

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When seeking access to personal information, an applicant must provide proof of identity in the form of a certified copy of any one of the following documents: * Only required when an applicant is requesting information on their own behalf.

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(maximum 10 MB per file; limit 3 files)
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FORM OF ACCESS

How do you wish to access the information?: *

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DISCLOSURE LOG

If the information sought is released to you and would be of interest to other members of the public, details about your application may be recorded in the agency’s ‘disclosure log’. This is published on the agency’s website.
Do you object to this?: *

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FEES AND CHARGES

The current Formal Access Application fee is $30.00. Please reference Councils prescribed schedule of Fees and Charges for further information. 

DISCOUNT IN PROCESSING CHARGES

You may be asked to pay a charge for processing the application ($30 / hour). Some applicants may be entitled to a 50% reduction in their processing charges. 

If you wish to apply for a discount, please indicate the reason: *

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Please upload any documentation to support your application, if applicable.
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Applicant signature: *

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