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Crash and Crime Permissible Information Request Form (Only for incidents in Western Australia)

Western Australia Police Information Release Centre Judicial Services, Office of Information Management

Public Trustee Building, 3rd Floor, 565 Hay Street Perth WA 6000. Enquires: (08) 9268 7800

Edited copies of crash file documents, statements or any information on the crash file can be obtained from Freedom of Information for a fee of $30.00, Tel (08) 9268 7774.

Photographs or diagrams can be obtained from Photographic Section/Forensics in Midland, Tel (08) 6274 8100.

Information in the Crash Permissible Report includes: crash file number, date and time incident occurred, police attendance, vehicles involved, parties involved, result of investigation/inquiry.

Information in the Crime Permissible Report includes: incident report number, time and date of incident, incident/offence description, incident /offence location, complainant details, total dollar value of incident/offence result, convicted person’s name only (not persons of interest or juveniles).

Consent of the complainant is required for all third party requests Incident Report Number ___________________________________

Crash File Number ___________________________________

Details of Complainant

Driver’s licence number | Car registration (Crash only)

Date of incident (dd/mm/yyyy)

Surname

First name | Date of birth (dd/mm/yyyy)

Address

Suburb/Town | Postcode

Telephone (H) | (W) Signature __________________________________________________ Date _____________________________

I have read, understood and agree to the terms (as set out in the disclaimer below) under which the

information is to be released. FEE: $36.30 (as at 1 July 2010) Disclaimer: "The information contained in this publication is made available in good faith and is derived from sources believed to be reliable and accurate at the time of publication. However, the information is provided solely on the basis that readers will be responsible for making their own assessment of the matters contained therein and that readers will verify all relevant representations, statements, information and advice. Changes in circumstances after publication may affect the accuracy of the information. No assurance is given as to the accuracy or completeness of any representation, statement, information or advice contained in this publication.

Neither the WA Police nor the State of Western Australia nor any employee or agent of the WA Police or of the State shall be responsible or liable for any loss, damage, or injury (including death) howsoever caused (whether caused by the negligent or other unlawful act or omission of, by or on the part of the WA Police, the State, or any agent or employee of the WA Police or the State arising from the use or reliance on any information, data or advice (including incomplete, out of date, wrong, inaccurate or misleading information, data or advice) expressed or implied in, or coming from, this publication by any person."