Application for Access to Documents under
Freedom of Information Act 1992 (FOI Act)
DETAILS OF APPLICANT
Title (Mr, Ms, Mrs, Dr, etc.):
Surname:
Given Name:
Preferred name:
Phone:
Email:
Postal address:
Organisation (if application is on behalf of an organisation):
DETAILS OF AGENT (if applying on behalf of the applicant)
Title (Mr, Ms, Mrs, Dr, etc.):
Surname:
Given Name:
Preferred name:
Phone:
Email:
Postal address:
Name of agent:
Information Type
Category of request (choose one):
Personal information (information about the applicant only. No application fees apply for
access to, and amendment of the applicant’s personal information. Please note, only personal
information about the applicant will be provided).
Non-personal information (information about persons other than the applicant -
a $30 application fee applies, and associated charges may also apply).
Request
Subject matter of the request:
Date range for request:
Please be specific and clearly describe the documents you are requesting (attach additional
sheets if necessary):
➢
Landgate may contact you to clarify the information you have requested and if necessary,
negotiate a reduction of the scope of your application if a significant number of documents are
involved.
PREFERRED METHOD OF RECEIVING CORRESPONDENCE IN RELATION TO THIS
APPLICATION
Please tick the appropriate box:
Email as specified above
Inspection of documents (only available at Landgate’s Midland office)
Hard copy via Australia Post
I require access in another form (please specify): ______________________________
PERSONAL INFORMATION
Please note: If you tick any of the boxes, Landgate may not need to locate and consult all officers
and/or third parties, which means the application may be dealt with quicker and, if applicable,
incur lower charges.
I consent to all personal information of WA state and local government officers being
deleted from the requested document/s
(information that would be removed: contact
details, phone numbers and signatures of Landgate’s officers and names, position titles,
contact details and signatures of other WA state and local government officers).
I consent to all prescribed details of Landgate’s officers being deleted from the requested
document/s
(information that would be removed: names and position titles of Landgate’s
officers).
I consent to all personal information of third parties being deleted from the requested
document/s
(information that would be removed: names, contact details, signatures and
identifying information of third parties that are not state and local government officers).
I consent to my name being disclosed to any third party that is consulted (as required by
section 32 and 33 of the FOI Act) and who requests to know the identity of the applicant of
this FOI application.
Providing this information to third parties who ask for it enables the
consultation process to be finalised more efficiently and quickly, as third parties are
generally more willing to consent to the release of personal and/or business information if
they are aware of who the applicant is.
FEES
• There are no fees or charges for applications for personal information
about the applicant.
• If you wish to access
non-personal information, you will need to pay the
$30.00 fee with this
application.
I wish to pay by:
Cash (in person)
Credit card
landgate.wa.gov.au
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Name on Card: ____________________________________
Signature of Cardholder: ___________________________
If you would like to pay by credit card, for security reasons do not write your credit card number on this
form. Following receipt of your application, a Finance Officer from Landgate will contact you by phone
to take your credit card details in order to process your payment. A receipt will be provided to you
within a few days.
I understand that before I obtain access to documents, I may be required to pay processing
charges in respect of this application and that, if appropriate, I will be supplied with a statement of
charges.
Yes
A reduction in
processing charges will apply if you hold a pension or concession card. Do you
wish to request a reduction in processing charges?
Yes – Please attach copy of proof of evidence, such as a Senior’s Card.
No
APPLICANT’S/AGENT’S SIGNATURE
____________________________________
Date: _________/__________/__________
LODGEMENT OF APPLICATION
By email:
xxx@xxxxxxxx.xx.xxx.xx
By mail:
FOI Coordinator
Landgate
PO Box 2222
MIDLAND DC WA 6936
In person
Landgate
Landgate
at:
1 Midland Square
Plaza Level
MIDLAND WA 6056
200 St Georges Terrace
PERTH WA 6000
landgate.wa.gov.au
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NOTES
FOI APPLICATIONS
•
Please provide enough information to enable the correct document(s) to be identified.
•
Landgate may request proof of your identity.
•
If you are seeking access to any document(s) on behalf of another person, Landgate will
require authorisation, usually in writing.
•
Your application will be dealt with as soon as practicable after it is received (and, in any
case, within 45 days).
•
Landgate may contact you to clarify your application.
•
The FOI Act is accessible online via the Parliamentary Counsel’s Office website
(https://www.legislation.wa.gov.au/) or is available for purchase from the State Law
Publisher (Telephone (08) 6552 6000) .
•
Further information can be obtained from the Co-ordinator, Freedom of Information,
Landgate on telephone (08) 9273 7373.
FEES and CHARGES (Freedom of Information Regulations 1993, Schedule 1)
The application fee for non-personal information is
$30.00.
Other Charges for Non-Personal Information:
•
Charge for dealing with the application are set at a standard rate of
$30.00 per hour, or pro
rata for a part of an hour.
•
Charge for supervising inspection of documents are set at a standard rate of
$30.00 per
hour, or pro rata for part of an hour.
•
Charge for photocopying of a document are:
$30.00 per hour, or pro rata for a part of an hour of staff time; and
$0.20 per copy.
•
Charge for time taken by staff transcribing information from a tape or other device is set at
a standard rate of
$30.00 per hour, or pro rata for part of an hour.
•
Charge for duplicating a tape, film or computer information will be the
actual cost.
•
Charge for delivery, packaging and postage will be the
actual cost.
•
The Regulations provide for a
25% reduction in charges (other than the application fee) for
financially disadvantaged applicants who, in the opinion of Landgate, are impecunious or
who hold a prescribed pensioner concession card.
If charges are estimated to be more than
$25.00 for the information, then the applicant will be
notified in writing and be given 30 days to make their intentions known.
landgate.wa.gov.au
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