Public Interest Disclosure Form v1
Do you work for a public authority?
Does this relate to one or more individuals?
When did the alleged events occur?
Summary of matters to disclosure:
Description of any documents provided or name/s of witnesses
Have you reported this information to any other person or authority?
By signing this form you agree that the information you have been provided is true and accurate to the best of your knowledge and understand that under Section 87(1) of the Public Interest disclosures Act 2002, it is an offence for a person to knowingly provide false information under the Act to certain officers (including the Ombudsman) with the intention that it be acted on as a disclosed matter. The provision provides for a maximum penalty of 240 penalty units or two year’s imprisonment, or both.
Leave this empty:
Your legal name
If you have questions about the contents of this document, you can email the document owner.
Document Name: Public Interest Disclosure Form v1
Agree & Sign