A FEE MUST ACCOMPANY THIS APPLICATION PROOF OF IDENTITY IS REQUIRED	Please use only UPPERCASE letters to complete form
DETAILS OF PERSON APPLYING FOR ACCESS TO SAPOL RECORDS
Name: (Mr, Mrs, Miss, Ms)	DOB:	/ /
(Family Name)	(Given Name/s)
Residential Address:	Postcode:
Telephone:	Email:	EXAMPLE@UPPERCASE.COM
COMPLETE THIS SECTION TO HAVE YOUR CORRESPONDENCE FORWARDED TO ANOTHER PERSON
Company and contact name:
Company Address:	Postcode:
Telephone:	Email:	EXAMPLE@UPPERCASE.COM
DETAILS OF REQUEST
In accordance with section 13 of the Freedom of Information Act 1991 I seek access to the following documents. Please describe clearly what documents you seek and include names of any other person(s) involved in incident, dates, times, locations and any other information which will help to identify the document(s). Your personal involvement in this request must be included.
IMPORTANT:	Pursuant to the Freedom of Information Act 1991, an application may take up to 30 days to be processed or longer for large or complex requests.
WAIVER OF FEE
Applications must be accompanied by such application fee as prescribed by the Freedom of Information (Fees and Charges) Regulations 2018, unless you are eligible for a fee waiver. A copy of a valid Concession Card, Pensioner Concession Card or Student Identification Card (full time) must be provided with this application should you wish to claim a waiver of the application fee. If you are unable to provide any of the above, you may be eligible to claim a waiver of the application fee based on financial hardship. Financial hardship must be evidenced and provided with this application by way of copies of bank statements or evidence of government payments such as a Crisis or Relief Payment.
NAME & SIGNATURE OF APPLICANT (Sign in presence of a member of SAPOL)
/ /
(Family Name)	(Initials)	(Signature)	(Date)
SAPOL USE ONLY (*Proof of identity of applicant is required and signature must be witnessed by a member of SAPOL)
* Driver’s Licence No.:	* Passport No.:	STATION STAMP HERE
* Birth Certificate: (sighted) * Other: (sighted)
PAYMENT
Amount Paid	$	Receipt No.:
OR Concession Card: (sighted & copy attached)	Financial Hardship: (sighted & copy attached)
I hereby certify that I witnessed the applicant’s signature, am satisfied as to the correctness of the identity of the applicant, the appropriate payment has been made; and/or valid concession or evidence of hardship is provided.
/ /
(Name)	(Rank / Class.)	(ID No.)	(Signature)	(Date)
IMPORTANT:	SCAN & EMAIL via SAPOL.FOI@POLICE.SA.GOV.AU to Freedom of Information Unit promptly FORWARD ORIGINAL to Freedom of Information Unit (100) by end of shift