Fillable pursuant to the Government Information (Public Access) Act (New South Wales)

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pursuant to the Government Information (Public Access) Act (New South Wales)

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NSW POLICE FORCE .
Access Application
Government Information (Public Access) Act 2009
Version: July 2020 Sensitive Page 1 of 6
Version: July 2020
Sensitive
Information for Applicants
THE INFORMATION YOU ARE SEEKING MAY ALREADY BE AVAILABLE TO YOU
Details concerning decisions made by NSW Police Force (NSWPF) in response to an application made
pursuant to the Government Information (Public Access) Act 2009 (GIPA Act), that may be of interest
to other members of the public, may be included on a Disclosure
Log. The NSW Police Force's
Disclosure Log provides details of:
The date the application was decided;
A description of the information to which access was provided;
A statement as to whether the information is now available to other members of the public and
How the information can be accessed.
To access NSW Poli
ce Force (NSWPF) disclosure logs or visit:
https://www.police.nsw.gov.au/online_services/requesting_information/disclosure_logs
DO YOU NEED INFORMATION RELEVANT TO AN INSURANCE CLAIM?
If you are seeking a copy of a motor vehicle crash or crime incident report (event only) that you have
reported for insurance purposes, please obtain this information through the NSWPF Insurance
Services Unit.
Visit: https://www.police.nsw.gov.au/online_services/requesting_information/request_for_incident_information
DO YOU NEED A NATIONAL POLICE CHECK CERTIFICATE?
The NSW Police Force provides an opportunity for NSW residents aged 14 years and above to apply
for a National Police Check for visa, adoption, employment (including authorisation as an authorised
carer), approval as a household member of an authorised carer, some occupational licensing
purposes, student placements and for volunteers working in Commonwealth supported aged-care
facilities.
Visit: https://www.police.nsw.gov.au/online_services/criminal_history_check
Individuals requiring a criminal record check for Australian citizenship, residency, spouse visa,
guardianship of a child from another country, working visa or whilst travelling or living abroad, must
apply via the Australian Federal Police (AFP). Details on applying for a criminal record check via the
AFP is available at
www.afp.gov.au. Non NSW residents must apply in the state they usually reside.
Visit: https://www.afp.gov.au/what-we-do/services/criminal-records/national-police-checks
DO YOU REQUIRE INFORMATION FOR A MATTER BEFORE THE COURT?
If documents are required for court proceedings, you may require a Subpoena.
A Subpoena is required for documents/materials are required for court proceedings. A subpoena is a
Court order, issued at the request of a party involved in a court proceeding. Subpoenas are issued in
both criminal and civil matters by any State or Federal court.
For further information, visit:
https://www.police.nsw.gov.au/online_services/requesting_information/subpoena
NSW POLICE FORCE .
Access Application
Government Information (Public Access) Act 2009
Version: July 2020 Sensitive Page 2 of 6
Version: July 2020
Sensitive
CORONIAL MATTERS
If the information you require relates to a deceased person/s whose death was investigated by the
State Coroner, please contact the Coroner's Office before completing this application, on telephone
no. (02) 8584 7777, or visit the State Coroner
www.coroners.justice.nsw.gov.au (as information in
relation to Coronial matters can only be released by the Coroner’s office).
DO YOU REQUIRE ACCESS TO EMPLOYEE PERSONNEL FILES?
Supervised access to your electronic personnel file (eP-file) will be provided upon request through
your Command.
PUBLIC INTEREST CONSIDERATIONS MEAN THAT SOME INFORMATION MAY NOT BE MADE
AVAILABLE TO AN APPLICANT
The full list of public interest considerations against disclosure can be found within the
GIPA Act, PART 2, DIVISION 2, SECTION 14 (click here to view). Some of the most
common public interest considerations against disclosure of information are listed below.
Where the information wou
ld:
reveal an individual’s personal information,
contravene an information protection principle under the Privacy and Personal Information
Protection Act 1998 or a Health Privacy Principle under the Health Records and Information
Privacy Act 2002,
prejudice any court proceedings by revealing matter prepared for the purposes of or in
relation to current or future proceedings,
prejudice the fair trial of any person, the impartial adjudication of any case or a person’s
right to procedural fairness,
reveal false or unsubstantiated allegations about a person that are defamatory,
expose a person to a risk of harm or of serious harassment or serious intimidation,
in the case of the disclosure of personal information about a child—the disclosure of
information that it would not be in the best interests of the child to have disclosed,
prejudice the prevention, detection or investigation of a contravention or possible
contravention of the law or prejudice the enforcement of the law.
INSTRUCTIONS FOR COMPLETING YOUR APPLICATION
Please complete this form to apply for access to information held by the NSWPF
pursuant to the GIPA Act. Please mark the relevant boxes with a tick.
If you require your personal information, you MUST provide a copy of your Proof of Identity
If you are making this application on behalf of another person, you MUST ensure that person
completes the ‘Authorisation’ section of this form or attach a separate authorisation
Government Information (Public Access) Act 2009 Sensitive ACCESS APPLICATION
Version: July 2020
Sensitive Page 3 of 6
SECTION 1 : APPLICANT
INDIVIDUAL
BUSINESS
Title
Company Name
First and Other Name(s)
Company ABN
Last Name
Your Reference Number
Previous / Other First Name(s)
Your Title / Position
Previous / Maiden Last Name(s)
Your First and Other Name(s)
Date of Birth
Your Last Name
Are you or the business acting on behalf of another person / party?
YES NO
If so, what is the name of the person / party?
Are you applying as:
Legal Representative Member of Parliament Media Representative
Member of the Public Other Staff / Former Staff Member
Contact Details
Unit Number / Street Number / Street Name
Suburb / Town / Locality / Post Code / State / Territory
Same as Residential or Business Address, or
Unit Number / Street Number / Street Name
Suburb / Town / Locality / Post Code / State / Territory
Preferred Alternate
Type of Applicant
Are you applying as an Individual or Business?
Government Information (Public Access) Act 2009 Sensitive ACCESS APPLICATION
Version: July 2020
Sensitive Page 4 of 6
SECTION 2 : INFORMATION REQUESTED
What information are you requesting?
Event Report(s)
Where you are requesting information for multiple Events, please supply information for each Event separately in the
‘Information Description’ section below
Event Number
Date of Incident
(if known)
Who / Where Incident reported to (if known) e.g. Officer Name / Police Area Command / Police Assistance Line / Other)
Involved party / parties
(if known)
Information Description
NOTE: If additional space is required please attach additional pages
PLEASE NOTE THAT PURSUANT TO SECTION 75 OF THE GIPA ACT,
THE NSW POLICE FORCE IS NOT REQUIRED TO CREATE A NEW DOCUMENT TO RESPOND TO YOUR APPLICATION.
e.
Describe the information you would like to access in enough detail to enable reasonable searches to be conducted,
g. car registration number, date of birth, location, Event numbers, other person(s) names, phone numbers, etc.
If your application is unclear as to the information you require, or you do not provide sufficient information, your
application may be deemed invalid.
Attach additional pages (if necessary) with any additional information that you feel will support your application.
Government Information (Public Access) Act 2009 Sensitive ACCESS APPLICATION
Version: July 2020
Sensitive Page 5 of 6
SECTION 3 : AUTHORISATION TO RELEASE PERSONAL INFORMATION
I am seeking my personal information
There is no requirement to complete this section
OR
I am seeking the personal information of another person
To be completed by the party whose personal information is requested
I authorise the NSW Police Force to release information about me as outlined in Section 2 of this Access
Application.
I acknowledge that the information requested may include my Criminal History.
I authorise the NSWP Police Force release my personal information to the Person / Legal Representative /
Company / Agency named in Section 1 of this Access Application.
Full Name Date of Birth
Address
Signature Date
PLEASE NOTE: Information may not be able to be released if authorisation is not provided
SECTION 4 : PROOF OF IDENTITY – INVOLVED PARTY
If seeking access to personal information, you MUST provide copy of one of the following proof of identify documents.
This is to comply with privacy requirements.
Australian Drivers Licence – with photograph, current address and signature
Current Australian Passport – with current address
Other proof of identity (e.g. Government issued identify or proof of age card) – with current address and signature
PLEASE NOTE: Information may not be able to be released if identification requirements are not fulfilled
SECTION 5 : APPLICATION FEE
I attach the $30.00 application fee by the following payment method (Do NOT send cash)
Cheque
Cheques and Money Orders must be made payable
to the NSW Police Force
Money Order
PLEASE NOTE: An Access Application cannot be deemed valid without receipt of the application fee.
SECTION 6 : PROCESSING CHARGES
A processing charge of $30.00 per hour may be applied pursuant to Section 64 of the GIPA Act. You will be notified
prior, if processing charges apply. Some applicants may be entitled to a 50% reduction in their processing charges.
Further information about this will be advised at the time of notification of additional processing charges.
Where information requested is considered ‘non‐personal’ additional charges will apply – you will be notified should
this apply to your application.
To make a secure payment via credit/debit card, make your application online instead
through the NSW Police Force Community Portal (portal.police.nsw.gov.au)
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signature
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Government Information (Public Access) Act 2009 Sensitive ACCESS APPLICATION
Version: July 2020
Sensitive Page 6 of 6
SECTION 7 : FORM OF ACCESS
Where information is located and able to be released, how do you wish to access this information?
A copy of the document(s)
Inspect the document(s)
Access in another way (please specify)
SECTION 8 : CONSULTATION
The GIPA Act requires an agency to consult with third parties when considering the potential release of other person(s)
information (pursuant to Section 54 of the GIPA Act).
Where consultation with a third party is required, the time to respond to your application will be extended by 10
working days.
Yes, I agree
When consulting, do you agree for this agency to provide your details as the
‘applicant’ to the other party and/or a third party?
(If you do not consent to our agency providing these details, this may impact on
the consulted agency’s/third party’s decision to release information).
No, I DO NOT agree
SECTION 9 : PRIVACY STATEMENT
The NSW Police Force (NSWPF) is subject to the Privacy and Personal Information Protection Act 1998 and the Health
Records and Information Privacy Act 2002 which require the NSWPF to comply with Information Protection and Health
Privacy Principles.
Your personal and/or health information is being collected to process your application for access to information under
Division 1 of part 4 of the Government Information (Public Access) Act 2009. The supply of your personal and/or health
information is voluntary, however the NSWPF may not be able to process your application if you do not provide it. Your
personal and/or health information will be used within the NSWPF for the purposes of processing your application.
The NSWPF will not disclose your personal and/or health information without your consent, unless authorised or required
to by law.
Your personal and/or health information will be held by the NSWPF at 1 Charles Street, Parramatta NSW 2150, which is
where all applications are processed. You have the right to access and correct your personal and/or health information.
SECTION 10 : APPLICANT’S SIGNATURE
Applicant’s Signature Date
SECTION 11 : APPLICATION LODGEMENT OPTIONS
NSW Police Force, InfoLink Unit Phone: 02 8835 6888 Monday to Friday between 08.30am and 4.30pm
NSW Police Force, InfoLink Unit,
Locked Bag 5102, Parramatta NSW 2124
APPLICANT CHECKLIST
Completed all pages of the Access Application form
Enclosed Payment
Provided proof of identity (person applications)
Completed Authorisation Section (where applicable)
Via Post
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Completed 27 November 2021

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