Fillable Access to Own Personal Records (New South Wales)

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Access to Own Personal Records (New South Wales)

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The Access to Own Personal Records (New South Wales) form is 1 page long and contains:

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Country of origin: AUSTRALIA
File type: PDF

Australia forms for New South Wales

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OFFICIAL: Sensitive - Personal
(when completed)
You may use this form to request access to your personal records under section 14 of the Privacy and Personal Information Protection Act 1998 or under
section 26 of the Health Records and Information Privacy Act 2002. If you need help in filling out this form, please contact Service NSW on 13 22 13.
To check the current fees payable visit roads-waterways.transport.nsw.gov.au, attend your nearest registry, service centre or call our Contact Centre on
13 22 13.
Hearing or speech impaired? Call us on the National Relay Service: TTY users phone 13 36 77 then ask for 13 22 13. Speak and Listen users phone
1300 555 727 and ask for 13 22 13.
WHEN TO USE THIS FORM
• Use this Form to check that we have recorded your personal details correctly.
• If you want us to search for and provide copies of your information rather than just check your details then use Form 5166 - Government Information
(Public Access) Act Application.
• If you require other information then please use Form 5166 Government Information (Public Access) Act Application
• If you are a solicitor seeking information please use Form 1046 - Motor Vehicle Accidents or Form 1757 - Marine Accidents
Access to Own Personal Records
Please describe the information you would like to access in enough detail to allow us to identify it (attach additional pages if
necessary). Note: If you do not give enough details about the information, Transport for NSW may refuse to process your
application.
Details of Applicant
Identification Documents
When seeking access to personal information, an applicant MUST provide proof of identity (POI) in the form of one of the following
documents.
Australian driver licence Current Australian passport Other
Catalogue No. 45062918 Form No. 943 (06/2021) Page 1 of 2
Personal Information
Transport for NSW is committed to protecting your privacy and ensuring your personal and health information is managed according to law. Find out
why we collect your personal information, including how we use and manage it, by reading our privacy statement at www.transport.nsw.gov.au/
privacy-statement or phone 13 22 13 to request a copy.
Applicant's signature: Date:
//
Personal Information Collection Notice
Mr / Mrs / Miss / Ms: Driver licence/Transport for NSW customer number:
Surname:
Australian postal address:
State: Postcode:
Daytime telephone number(s): Facsimile:
Email:
Transport for NSW will only release information directly to the Applicant and not the Applicant's agent or solicitor.
Further details about acceptable POI documents are
available at roads-waterways.transport.nsw.gov.au
Given names:
YesCertified extract required: No
Online licence renewal declaration required? Yes
(Please indicate reasons below)
OFFICIAL: Sensitive - Personal
(when completed)
Office use
Stand alone or primary proof Document number
Secondary proof (if necessary)
Proof of Identity Record
Document number
Certified by:
Customer service representative name (print)
Service centre
Customer service representative signature
DateStaff number
day month year
/ /
Page 2 of 2Catalogue No. 45062918 Form No. 943 (06/2021)
Please do not send cash
Take the completed request for information application to your nearest service centre or send it to:
Transport for NSW
Customer Administration Unit
Locked Bag 14
Grafton NSW 2460 Australia
If payment is being made using the credit card payment authority you may also submit your application
by fax on +61 02 6640 2895 or email to customeradministrationunit@transport.nsw.gov.au
You must include copies of proof of identity (POI) documents with your application
or the request will not be processed.
Further details about acceptable POI documents are available at roads-waterways.transport.nsw.gov.au
Credit Card Payment Authority
MASTERCARD VISA
Card number
$
Signature of card holder
Card holder's name Amount
Valid until
Remember – include your documents with this Authority
My supply of Credit Card information is voluntary and I understand that my 'personal information' may be disclosed inside and outside NSW to
Transport for NSW Bank and my financial institution for the purpose of administration and processing Credit Card Payment.
/
To check the current fees payable visit roads-waterways.transport.nsw.gov.au, attend your nearest service centre or
call our Contact Centre on 13 22 13.
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Access to Own Personal Records (New South Wales)

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Completed 25 October 2021

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