Application for Access to Documents
under the
Freedom of Information Act WA 1992 (s.12) (FOI Act)
Applicant Details
Title (Mr, Ms, Mrs, Dr, etc.):
First name:
Last name:
Preferred name:
Phone:
Email:
Postal Address
(for receipt of notices under s. 12(1)(c)
Organisation
(If you are seeking access to document/s on
of the FOI Act
, provide a postal address in Australia):
behalf of another person or organisation, a signed and dated
statement of authority must be included with the application)
Information Type (choose one only)
☐ Personal Information
A request for access to documents containing your personal information only; can
(no fee)
include your name, identifying details, contact information, personal images or other
identifying matter.
☐ Attached are two forms of personal identification.
☐ Non-personal Information
A request for access to documents containing information that is not limited to your
($30)
personal information.
☐ Attached is a cheque/money order for the application fee.
OR
☐ Electronic payment of the application fee has been made via Bpoint link
CTRL + CLICK on icon link.
Provide your name as the reference.
Receipt number is:
Scope of FOI Application
Subject matter of the request:
Date/s or range of dates of requested document/s:
Details of document/s being requested:
(Please provide specific information to identify relevant documents and refrain from using descriptive terms that are all
encompassing such as ‘all documents relating/pertaining to’. Attach additional sheets if necessary)
Personal Information (tick all boxes that apply)
☐ I consent to all ‘personal information’ of third parties being deleted from the requested document/s
(information that would be removed as out of scope; names, contact details, signatures and identifying information of third
parties that are not government officers)
☐ I consent to all ‘personal information’ of all government officers being deleted from the requested document/s
(information that would be removed as out of scope; contact details, phone numbers and signatures of all government
officers)
☐ I consent to ‘prescribed details’ of all government officers being deleted from the requested document/s
(Information that would be removed as out of scope; names and position titles of all government officers) Functions and
duties of an officer would remain in scope.
Please note: If you tick any of the above boxes this means that the agency may not need to consult as widely, which
means applications may be dealt with quicker and incur lower charges.
☐ I consent to my name being disclosed to any third party that is consulted (as required by sections 32 and 33
of the FOI Act) who requests to know the identity of the applicant.
(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 the applicant is known)
To complete the FOI application please sign below and lodge with the Department of Primary Industry
and Regional Development (see ‘lodging an application’ below for contact details) Applicant signature: ________________________
Date: ___/___/______
Lodging an application
Please note: FOI applications are not valid until BOTH
application form and
payment of the application fee
(if applicable) have been received. It is recommended that applications be sent via email to xxx@xxxxx.xx.xxx.xx
and payment made via BPoint to ensure that they can be processed as soon as possible. Alternatively
applications can be sent to;
Information Release and Privacy Team
Tel: (08) 6552 1829
Locked Bag 4
Email: xxx@xxxxx.xx.xxx.xx
Bentley Delivery Centre WA 6983
Notes
Please provide sufficient information to enable the correct document/s to be identified.
In accordance with s.29 of the FOI Act, the agency may request proof of your identity.
If you are seeking access to document/s on behalf of another person or organisation, DPIRD will require authorisation
in writing.
Your application will be dealt with as soon as practicable and within the time specified in the FOI Act (45 days after a
valid application is received). However, should more time be required the DPIRD may request an extension of time from
you/or the Information Commissioner.
Forms of access
You can request access to documents by way of a copy of a document, this can be sent to you electronically via email.
Where the agency is unable to grant access in the form requested, access may be given in a different form. DPIRD’s
preferred method of providing access to documents is via a secure sharing platform, Objective Connect.
Charges for processing applications
Before obtaining access to documents you may be required to pay processing charges.
You will be supplied with an estimate of charges if appropriate.
Discounts may be available in certain cases. For example; if you are considered financially disadvantaged and/or are
the holder of a pensioner concession card a reduction in processing charges may apply. (Application fee of $30 cannot
be waivered for non-personal information)
If you consider yourself entitled to a reduction, please advise when lodging your application and attach copies of pension
card/s or other documentation to support your request.
