FOI Application Form
Access to documents held by the Sport and Recreation (WA), a division of the Department of Local Government, Sport and Cultural Industries
(under the Freedom of Information Act 1992, S.12)
Hon/Dr/Mr/Mrs/Miss/Ms
First name:______Surname:______
Postal address______
State:______Postcode:______Telephone number:______
Email ______
Note: Sport and Recreation (WA) will not be able to consider your FOI application as valid if you do not provide a valid Australian Postal address which all correspondence can be sent to.
Application scope
Personal information [ ] Non-personal information [ ] I am applying for access to the following document(s): ______
(Please attach additional sheet if necessary and please specify the exact information required, include any dates if relevant). If the scope of your request is found to be large you may occur additional costs(see page 2) or you maybe asked to consider narrowing the scope of your request.
If applying on behalf of a client or organisation
Organisation name: ______
Client name: ______
Note: If you are seeking access to a document(s) on behalf of another person, we will require written authorisation from that person/s confirming that this is indeed the case.
Fees and charges
1. Type of feePersonal information about the applicant (s.9) / No fee
Application fee (for non-personal information) / $30.00
Processing fees
2. Type of charge
Charge for time dealing with the application (per hour or pro rata) / $30.00
Charge for access time supervised by staff (per hour or pro rata) / $30.00
Photocopying staff time (per hour or pro rata) / $30.00
Per photocopy / $0.20
Transcribing from tape, film or computer (per hour or pro rata) / $30.00
Duplicating a tape, film or computer information / Actual cost
Delivery, packaging and postage / Actual cost
3. Deposits
Advance deposit of the estimated charges may be required / 25%
Further advance deposit may be required to meet the charges for dealing with the application / 75%
Attached is a cheque or money order for the amount of $30.00 to cover the application fee. I understand that before the Sport and Recreation (WA) provides access to documents, I may have to pay processing charges and when this occurs I will be supplied with a letter relating to the statement of additional fees and/or charges that would be incurred prior to the Sport and Recreation (WA)proceeding with, or finalising the processing of, the FOI request refer to s. 17 (2) Freedom of Information Act 1992 (FOI Act). You must notify the agency (within 30 days) of your intention to proceed. In some instances the agency may request an advance deposit. If you are financially disadvantaged advise the department as a 25% reduction of charges may apply.
If you are applying to access personal information there is no application fee, however for identification purposes you will need to attach a photocopy of your identification document to this application and sign below.
Applicant’s signature: ...... Date: ...... /...... /......
Lodgement of applications
By post, addressed to:
FOI Coordinator
Sport and Recreation (WA)
PO Box 329 Leederville WA 6007
In person at
FOI Coordinator
Sport and Recreation (WA)
246 Vincent Street Leederville WA 6000
(8.30am – 5pm)
Please do not hesitate to contact the FOI Coordinator on 08 9492 9700 if you require any further information.
The Freedom of Information Act 1992 (FOI Act) is available onlineor it can be purchased from the State Law Publisher, 10 William Street, Perth 08 6552 6000 or email .
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Trim reference: 2014/362/18 last updated 16/10/2016