Department of Communities Tasmania (CT) Right to Information Act 2009 Application for Assessed Disclosure Applicant’s Details: Family Name: Title: Given Name/s: DAY TIME CONTACT INFORMATION: Email: Postal Address: STATE: POSTCODE: Business Home Mobile Telephone: YES NO Application Fee ($39.50) included (please OR select) Member of Parliament Application for Waiver of Fee: Financial Hardship * General Public Interest or Benefit** * If claiming Financial Hardship, you must attach evidence that you are in receipt of Centrelink or Veterans Affairs payments. **If claiming public interest, you must show how the information will be used for a purpose that is of general interest or benefit to the public. Public Interest: For the release of your personal information, you must provide photo identification or a copy of photo Proof of identity provided: identification which has been certified as a true copy by a Justice of the Peace or a Commissioner for Declarations Details of efforts made prior to this application to obtain this information:
Department of Communities Tasmania (CT) Right to Information Act 2009 Application for Assessed Disclosure Applicant’s Details: Family Name: Title: Given Name/s: DAY TIME CONTACT INFORMATION: Email: Postal Address: STATE: POSTCODE: Telephone: Business Home Mobile Application Fee ($39.50) included (please select) YES OR NO Application for Waiver of Fee: Member of Parliament Financial Hardship * General Public Interest or Benefit** * If claiming Financial Hardship, you must attach evidence that you are in receipt of Centrelink or Veterans Affairs payments. **If claiming public interest, you must show how the information will be used for a purpose that is of general interest or benefit to the public. Public Interest: Proof of identity provided: For the release of your personal information, you must provide photo identification or a copy of photo identification which has been certified as a true copy by a Justice of the Peace or a Commissioner for Declarations Details of efforts made prior to this application to obtain this information:
CT_RTI_Application_Form_2018-19_V5.docx