Current Details Payment Complete Please complete this form to apply for formal access to government information under the Government Information (Public Access) Act 2009.APPLICATION FEE A $30.00 application fee must accompany a Formal Access to Information Request. Applicant Details First name Last name Business Phone Mobile Phone Email Postal Address ABN Number Business Name Is the Applicant information (above) the same as the billing details? Yes No First name Last name Business Phone Mobile Phone Email Postal Address ABN Number Business Name Preferred Contact Method By telephone By email By post Government Information Please describe the information you would like to access Please include the necessary supporting documents Maximum 5 files.100 MB limit.Allowed types: pg jpeg pdf doc docx xls xlsx zip. Note: If you do not provide sufficient detail about the information you are seeking, Council may refuse to process your application. Personal Information Are you seeking personal information? Yes No Reason why information is required Upload proof of identity Maximum 5 files.100 MB limit.Allowed types: gif jpg jpeg png svg txt pdf doc docx xls xlsx ppt pptx zip. Note: For personal information, an applicant must provide proof of identity. How Would You Like to Access the Information Access Method I would like them emailed to me I would like to view them at the Customer Service Centre *30 minute appointments only. I would like this information posted to me Prefered day for viewing? Tuesday Wednesday Thursday Prefered time for viewing? 10:00am 10:30am 2:30pm 3:00pm One of our friendly Customer Relations Officers will contact you with a viewing date & time based on your preferences above. Disclosure Log Do you object to information being recorded on the Disclosure Log? Yes No 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 AlburyCity website. Processing Charges If your application to access information is approved, additional processing charges will apply ($30.00 per hour). Processing charges will be invoiced to the applicant via the applicant's details (email or post).Some applicants may be entitled to a 50 per cent reduction in their processing charges. Do you wish to apply for a discount? Yes No Please select reason Financial hardship (eg. Pension or Centrelink Card) Special benefit to the public Please attach supporting documentation One file only.10 MB limit.Allowed types: jpg jpeg png pdf doc docx. Applicant's Declaration I acknowledge there is a charge, as shown in Councils adopted fees and charges, for Council to provide copies of the documents I request. I acknowledge that Copyright exists on each document. I understand I must seek the Copyright owners consent in order to use any part of a copyright document for any other purpose. Signature Sign above Privacy and personal information protection noticeIn making this application, you are providing personal information. This information will only be used in connection with this application and will be handled in accordance with the Privacy and Personal Information Protection Act 1998. General information about the Government Information (Public Access) Act 2009 is available by calling the Office of the Information Commissioner on call 1800 472 679 or on its website www.ipc.nsw.gov.au
