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Western Australia Police

Police Freedom of Information Application Freedom of Information Request

(Pursuant to the Freedom of Information Act 1992)

Applicant Details

Surname ________________________________ Given Names ________________________________

Australian Contact Address ______________________________________________________________

___________________________________________________________________ Postcode ___________

Daytime Contact Number _________________________ Mobile ______________________________

Agent/Representative’s Name and contact details (if applicable) ______________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

Details of Request (Please tick the appropriate box and provide details)

Request for documents containing personal information only.

Request for documents including Non-Personal documents – information relating to third parties. This attracts an application fee of $30.00 payable at the time of applying, either by cheque or money order made payable to the Commissioner of Police.

Please describe clearly the documents you are requesting access to (include dates, location, subject matter or any other information that would enable the requested documents to be identified). Please specify actual documents rather than entire files. Your reason for access (optional) may assist in the accurate capture of documents: __________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

Please complete the following details if relevant to your request:

Name of attending police officer (if known) ________________________________________________

Incident Report Number (if known) ________________________________________________________

If Road Traffic Crash - Crash File Number (if known) _______________________________________

Date of incident (if known) ______/______/_________

Location of incident (if known) ____________________________________________________________ __________________________________________________________________________________________

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Form of Access (Please tick the appropriate boxes)

I wish to inspect the document(s) Yes No

I require a copy of the document(s) Yes No

I require access in another form Yes No Please specify ___________________________________________________________________________ Proof of ID is required before any documentation is released. This can be in the form of a Driver’s Licence, Passport or Centrelink document if you have no other form of ID.

Fees and Charges – Non-Personal Applications Attached is a cheque/cash to the amount of $ .................... to cover the application fee. I understand that before I obtain access to documents I may be required to pay processing charges in respect of this application and that I will be supplied with a schedule of documents with a view to reducing my ambit of application or accept the charges if appropriate. In certain cases a reduction in additional charges may apply. This only applies to processing charges. The application fee for non-personal information has to be paid in all cases. If you consider you are entitled to a reduction, submit a request with copies of documents that address the criteria. Refer to the notes on fees and charges on the following page.

I am requesting a reduction in additional charges Yes No (Please tick the appropriate box) (this relates to large files that require estimate of charges)

Reason __________________________________________________________________________________ Applicant’s Signature ___________________________________________________________________

Date _/ /_______

* If Applicant has not signed this form and an agent is acting on their behalf, a signed and dated

statement of authority must be included with application.

Office Use Only Receipt No: Date of Receipt _/ /_______

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NOTES FOI Applications

• Please provide sufficient information to enable the correct document(s) to be identified.

• The agency may request proof of your identify.

• If you are seeking access to a document(s) on behalf of another person, the agency will require authorisation, usually in writing.

• Your application will be dealt with as soon as practicable (and, in any case, within 45 days) after it is received.

• The Freedom of Information Act is available for purchase from the State Government Bookshop, 815 Hay Street, Perth [Telephone (08) 9222 8216].

• Further information can be obtained from the Police FOI Coordinator, Information Release Centre [Telephone (08) 9268 7774].

Forms of Access

You can request access to documents by way of inspection, a copy of a document, a copy of an audio or video tape, a computer disk, a transcript of a recorded document or of words recorded in shorthand or encoded form, or a written document in the case of a document from which words can be reproduced in written form. Where the agency is unable to grant access in the form requested, access may be given in a different form. Fees and Charges

• No fees applicable for access applications relating to personal information and amendment of personal information.

• No charges applicable for amendment of personal information.

• An application fee of $30 for other access applications (non-personal information).

• No fees applicable for an internal or external review.

• A fee of $30 (pro rata for processing charges may be applicable).

• Photocopies charged at the rate of 20 cents per copy.

• Actual cost to the agency charged for postage, special arrangements for access and for specialised access such as reproductions and the like.

• Additional charges will be waived or be reduced if the applicant is impecunious. Documentation is required confirming they are impecunious.

Lodgement of Applications

Applications may be lodged –

By post: Police FOI Coordinator Information Release Centre Office of Information Management WA Police Locked Bag 35, Perth Business Centre WA 6849

In person: Police FOI Coordinator Information Release Centre Office of Information Management WA Police Public Trust Building Level 3, 565 Hay Street PERTH WA 6000