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Request for Release of Personal Information form

Why do we need this information?

To locate and release personal information we need certain details from you. These details confirm that you have the authority to receive the records and they help us search the archives.

What if I do not have all the information?

We understand you may not be able to provide all the information requested. We will try to help you as much as we can with what you give us. The more you can provide the more widely we can search the records.

If you need help to fill in this form please contact the Heritage Service on 03 9429 9266.

Applicant details

(Proof of ID Required for ALL Applicants)


Personal information requested


Attachments

To meet Privacy requirements, we ask for documents of identification. 

Copies of these documents can be uploaded here, or posted, or scanned and emailed to the following details:


The Heritage Service, Client Information and Support

Berry Street

1 Salisbury Street, Richmond 3121


Email: Heritage@berrystreet.org.au


If the records are your own:


If the records are a relative's:


If requesting records for a person who is unable to provide consent:


If requesting records for a person who is no longer living, please provide:


For Aboriginal or Torres Strait Islander people who don’t have documentation listed above

Proof of identity and proof of connection to family members can include an endorsed genogram, Certificate of Aboriginality or confirmation in writing from such groups as Link Up. The Heritages Service will consult with the organisation that produced the documentation.


Confirmation

Type your name to sign/authorise