Application Fee or Application to Waive the Fee: Application fee included (please tick) Cheque or order payable to Department of Justice for $38.75 Or Pay to Department of Justice Operating Account at Westpac BSB 037001A/C No. 267793 – please include a payment reference - and your name e.g. RTI AX Smith “RTI” (fee current as at 1 July 2017) YES/NO Office Use: Fee Received and Receipted: OR Application Member of Financial Hardship General public for waiver: Parliament, in interest or benefit (eg holder of a relation to official (you will need to (please Commonwealth Health business show that you indicate Care Card) intend to use the category) information for this purpose) Reason Application fee should be waived: (If is insufficient room in the space provided please attach further details.) Proof of Identity: If application is for release of your personal information you must provide proof of identity before we can release the information if lodging by email or mail you will – need to provide certified copies. (please tick if this applies to you) YES/NO Office Use: Proof of Identity Sighted/Received and Acceptable Details of the information sought:
Application Fee or Application to Waive the Fee: Application fee included (please tick) Cheque or order payable to Department of Justice for $38.75 Or Pay to Department of Justice Operating Account at Westpac BSB 037001A/C No. 267793 – please include a payment reference - “RTI” and your name e.g. RTI AX Smith (fee current as at 1 July 2017) Office Use: Fee Received and Receipted: YES/NO OR Application for waiver: (please indicate category) Member of Parliament, in relation to official business Financial Hardship (eg holder of a Commonwealth Health Care Card) General public interest or benefit (you will need to show that you intend to use the information for this purpose) Reason Application fee should be waived: (If is insufficient room in the space provided please attach further details.) Proof of Identity: If application is for release of your personal information you must provide proof of identity before we can release the information – if lodging by email or mail you will need to provide certified copies. (please tick if this applies to you) Office Use: Proof of Identity Sighted/Received and Acceptable YES/NO Details of the information sought:
RTI_assessed_disclosure_16-17_2.docx