FOI Application - Shire of Perenjori

Freedom of Information Application Form

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Mobile Phone*
Home Phone
Work Phone
Is this application on behalf of an organisation?*
- Yes
- No
Organisation Name*
Organisation Representative/Agent Name*
Details of Request
Details of Request*
- Request for Documents containing Personal Information
- Non-Personal Documents that contains information relating to third-parties
Request for Documents containing Personal Information:
This is information about an identifiable individual and includes certain information within their personnel file, job applications, financial records, academic and medical records etc. Proof of Identity May be Required.

Indicate date/s ranges for the requested document/s*

Document Name	Start Date	End Date

Reason for access to these documents?*
This may assist in accurate identification of documents.
- Personal Information of Third Parties and Prescribed Details of Government Officers
- Please Note: deleting all personal information and/or prescribed details (such as names, positions, titles, addresses, phone numbers, email addresses and signatures) means that the Shire of Perenjori may not need to consult with those third-parties which will mean your application will most likely be dealt with quicker. However, consultation with third parties may still be necessary in relation to any commercial/business information contained in the requested documents.
- Consent
  I consent to all “Personal Information” of third parties being deleted from the requested documents.
  I agree
- Consent
  I consent to all “Prescribed details” of agency/government officers being deleted from requested document/s.
  I agree
How do you wish to access these documents?*
- I wish to view these document/s in person (at the Shire Administrative building)
- I require a copy of the document/s
Fees and Charges
No fees or charges apply for access to personal information or the amendment of personal information. Applications for other documents (i.e. non personal documents) require a $33 application fee to be paid when the application is lodged.

Please ensure you include your $33application fee and you understand that before you obtain access to documents you may be required to pay processing charges in respect of your application. An estimate of charges will be provided in advance should these charges exceed $25
- FOI Photocopies are charged at $0.22 (22cents) per A4 copy
- FOI Labour in Processing an Application is charged at $44.00 per hour.
- FOI Labour for Supervising Access to documents is charged at $66.00 per hour.
- FOI Labour in photocopying documents is charged at $44.00 per hour.
- Information approved for release can be made available in an electronic form (PDF) to reduce costs.
- Fees do not apply for personal information, only or for internal and external reviews
- Additional charges will be waived or reduced if the applicant can prove impecunious status.
Additional Information
- Please provide sufficient information to enable the correct document/s to be identified.
- You may be required to prove your identity.
- If you are seeking access to a document/s on behalf of another person, Council will require a written, signed and dated statement of authority from that other person.
- Your application will be dealt with as soon as practicable (and, in any case, within 45 days) after it is received subject to confirmation that the applicant wishes to proceed with the estimated charges.
- The Freedom of Information Act is available to download for free from the State Law Publisher at www.slp.wa.gov.au
- Further information can be obtained from Council’s Chief Executive Officer.
If you are lodging an application on behalf of another person, you must provide authorisation in the form of a letter signedby that person.
Authorisation*
I have read the shire of Perenjori’s Freedom of Information Procedures and understand that some requested information may not be available (as stipulated under the Freedom Of Information Act 1992).
Yes, I understand
Signature*
Unique ID
Comments
This field is for validation purposes and should be left unchanged.

Freedom of Information Application Form

Details of Request

Personal Information of Third Parties and Prescribed Details of Government Officers

Fees and Charges

Additional Information

Council

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