Application for Request for Information Form

Please note that for legal reasons discourse with police is strictly in written format.

Acknowledgement is made that any information required from police is subject to a FOI
(Freedom of Information) Request Form incurring a non-refundable application fee together with
other associated access charges, as described in regulations.

It is therefore also required that the same commercial transaction occur with regards to providing
information to an employee of police for our time and limited resources available in order to help
police with enquiries.

Send this form, together with a non-refundable application fee of $84.50 payable by bank cheque,
money order or direct deposit to the person’s name as listed at the bottom of this page.

Note: (1). An invoice will be sent to the applicant with a receipt for application fee based on
costs as detailed on page 2. Payment must be received in full before any requested information
may be provided.

(2). The request for information may be declined without reasons given.

Date :
Full Name of Officer :
Reg. No. :
Police Station Address :
Police Main Trading
Name and ABN :
Note (3)
Postcode :
Police Station Fax :

I am applying to obtain the following information:

Continue to page 3

Payable to:

Name: Address: BSB: Acc. No:

Application for Request for Information Form Page 1 of 3

 SCALE OF COSTS AND CHARGES

Drafting and producing letters (including fax or email) $42 per 100 words

Circular letter – forwarding copy letter or document $18

Preparing an exhibit $23 per exhibit

$3 per page ( 1 – 30 pages)

Copy or other reproduction of document
$2 per page ( 31 and more)
Transmitting of documents (fax / email / letters):
- From own resources $14 for first page
$9 per page thereafter

- From external resources (e.g. Australia Post) $17 for first page
$10 per page thereafter

Extraction of information from electronic devices such as $12 per item / file
smart phones, voice recorders, surveillance cameras, etc
Provide the information on a CD/DVD $12.50 per disc
Attendance to; file or deliver a document; police station;
$14.50 (per 5 minute period)
court or any other premises

Note (3). The ABN and Main Name or Main Trading Name of the police officer’s employer
must be supplied in order for the application form to be processed, as listed in the example below:
Main Name: POLICE DEPARTMENT (VIC,) Main Trading Name: VICTORIA POLICE, ABN: 63 446 481 493

Note (4). Should more pages be required, a copy of the third page can be made as many times
as needed to accommodate request for information from the applicant.

Current as of 1 July 2016

Application for Request for Information Form Page 2 of 3

I am applying to obtain the following information (continued):

SIGNATURE OF APPLICANT / OFFICER: ___________________________________________

Application for Request for Information Form Page 3 of 3