GIPA Act - Application Form

GIPA Act online application form for Department of Customer Service.

Required fields are marked with an asterisk (*).
Your details
I agree to receive correspondence at the above email address *

Proof of identity

If you are seeking access to any personal information (including your own), you will need to provide proof of identity or authorisation from the person to which the personal information belongs. Please attach documentation to your application.

Identity type

Application fee

The application fee for an access application is $30. This fee must be paid to successfully lodge an application

If paying by cheque or money order, please attach cheque to application form, payable to "Department of Customer Service".

If paying by EFT, please follow payment instructions below.
Subject description: Your surname - GIPA application fee
Pay: Department of Customer Service
ABN: 81 913 830 179
Bank: Westpac
BSB: 032 001
Account number: 203164

Payment type *

Government information

Please describe in detail the information you would like to access. If you do not provide enough detail we may not be able to process your application.

Discount of processing charges

You may be asked to pay a fee of $30 an hour for processing your application. Some applicants may be entitled to a 50% reduction of processing charges on the grounds of personal hardship or because the information sought is of special interest to the public. If you wish to apply for a discount on the processing charges, please indicate the reason:

  • For financial hardship, please attach supporting documentation - copy of pension, Department of Human Services or student card
  • For not-for-profit organisation, please attach supporting documentation
  • For special benefit to the public, please attach supporting documentatio
Discount reason
Maximum file size 2MB, only pdf, doc, docx file types allowed

Disclosure log

If the information you have requested is released to you and would be of interest to other members of the public, details about your application may be recorded in the agency’s ‘disclosure log’. This is published on the agency’s website. We will not publish personal information on the log.

Do you object to this? *
Accessing the information
How do you wish to access the information? *

Consultation

We may need to consult with third parties before deciding your application. Please indicate in the boxes below whether you consent to the release of the following information to any third parties. This information will assist any third parties to understand why you are seeking the information.

Your name? *
Details of information you are seeking? *

Contact

If you require assistance lodging this application you may call the GIPA team on 02 9619 8672 or send an email to gipa@customerservice.nsw.gov.au.

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