PAIA / FORM 2 / REGULATION 7

Request for Access to a Record

Complete the statutory request form below. Proof of identity must be attached. Where the request is made on behalf of another person, proof of authority must also be attached.

Secure browser formEmail submissionPrint-ready record

FORM 2Request for Access to Record

1. Request capacity

Request is made in my own nameRequest is made on behalf of another person

2. Requester personal information

Full namesIdentity numberCapacity in which request is made (when acting for another person)Postal addressStreet addressEmail addressBusiness telephoneFacsimileCellular number

3. Person on whose behalf the request is made (if applicable)

Full namesIdentity numberPostal addressStreet addressEmail addressBusiness telephoneFacsimileCellular number

4. Particulars of record requestedDescription of record or relevant part of the record

Reference number, if availableAny further particulars

5. Type of record

Written or printed record Virtual images, including photographs, slides, videos, computer-generated images or sketches Recorded words or information reproducible in sound Record held on a computer or in electronic or machine-readable form

6. Form of access

Printed copy of the record Written or printed transcription of virtual images Transcription of soundtrack Copy on flash drive Copy on compact disc Copy saved on a cloud storage server

7. Manner of access

Personal inspection at the registered address Postal services to postal address Postal services to street address Courier service to street address Facsimile of written or printed information Email of information, including soundtracks where possible Cloud share or file transfer

8. Right to be exercised or protectedIndicate which right is to be exercised or protectedExplain why the requested record is required for the exercise or protection of that right

9. Fees and exemption

A request fee may be payable before the request is considered. Any access fee depends on the form of access and the reasonable time required to search for and prepare the record. You will be notified in writing of approval or refusal and, if approved, any costs payable.

Reason for exemption from payment of a fee, if applicable

10. Preferred correspondence

Postal addressFacsimileElectronic communication

Please specify details

11. Supporting documents

Proof of identityAttach this file manually to the email that opens.Proof of authority (where applicable)Required when acting for another person.

12. Declaration and signature

Signed atDateTyped full name as electronic signature