NORTHERN TERRITORY POLICE REQUEST FOR ROAD TRAFFIC ACCIDENT INFORMATION TO by theredman

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									                                                       NORTHERN TERRITORY POLICE

                                       REQUEST FOR ROAD TRAFFIC ACCIDENT INFORMATION

TO:         Accident Records Clerk                                                             Police Ref:
            NT Police, Fire & Emergency Services
            PO Box 39764                                                                                 Our Ref:
            WINNELLIE NT 0821
                                                                                                         Date: ______/______/_________

            Telephone: 08-89223510                                                             Fax: 08-89223357


I/We (name & address of applicant) ________________________________________________________________________


_____________________________________________________________________________________________________


Wish to apply for information in relation to Motor Vehicle Accident, details of which are as follows:


Date of Accident: _______________________________________________________________________________________


Location of Accident: ____________________________________________________________________________________


Driver/s or Pedestrian/s: _________________________________________________________________________________


Vehicle Registration No/s: ________________________________________________________________________________


Member/Police Station reported to: _________________________________________________________________________



I/We request:                                                        (Fees $28.00 Search Fee plus 55c per photocopy page)

[     ]     A copy of Road Accident Report

[     ]     A copy of a Statement (Authority for release to me is attached)

[     ]     A copy of Blood Alcohol Certificate (Authority for release to me is attached)

[     ]     Permission to Interview Investigating Police Officer ($28.00 per half hour or part thereof).

            Establishment of Interest (applicant to state reason and the basis on which a bonafide interest in the information is
            claimed).

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________


Signature of applicant: _______________________________________                                Date: _______________________________

                                                   FOR ACCIDENT RECORDS USE ONLY
To Accident Records              Receipt No.                    Amount Received                          Copy Supplied:




     Northern Territory Police, Fire and Emergency Services (NTPFES) is collecting information on the application form for Road Traffic Accident
       Information. The collection of this information is authorised under the provisions of the Police Administration Act. Failure to provide this
    information may result in your application not being processed. You can access your personal information provided on this form. If you have
                          any queries or wish to access this information please contact NTPFES by phoning (08) 89223242.

								
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