/ W004 / Woomera Prohibited Area Coordination Office
NOTIFICATION OFESCORTED PERSON
Pursuant to Woomera Prohibited Area Rule 2014 use this form to:
Notify Escorted Person details for accesstothe Woomera Prohibited Area (WPA).

INSTRUCTIONS
(1) Form completion

  • All questions are to be answered:
If a question is not applicable, enter N/A or if the answer is not known, enter N/K.
  • Information is to be provided in English.
  • Dates are to be provided in full using the DD/MM/YYYY format.
  • Do not use abbreviations or acronyms.
  • Photographic Identification:
Applications must include a copy of photographic identification issued by a Commonwealth or State Government body (for example – Passport or Drivers Licence). An International Passport may be acceptable if no Commonwealth or State Government issued identification is available. An International Passport in a language other than English must be accompanied by a certified English translation.
The copy can be a scanned image or photocopy of both sides of the identification document and should be attached to this form.
  • The notification must be completed in full or will be returned for resubmission.

(2) Form submission

  • Once completed by the individual, the form should be given to the Permit Holder.
  • The Permit Holder should submit the form to the Woomera Prohibited Area Coordination Office:
Email: (preferred method)
Mail: WPACO
R1-1-D Zone
PO Box 7901
Canberra BC ACT 2610

(3) Access to the Woomera Prohibited Area

  • The notificationof Escorted Person does not give a right of entry onto the Woomera Prohibited Area.
  • The Permit Holder mustseek approval for the Escorted Person to enter the Woomera Prohibited Area.
  • The Access Request Form, W007 is available from the Woomera Prohibited Area Coordination Office website at The completed form W007 is to be submitted to the WoomeraTestRange:
Email: (preferred method)
Mail: WoomeraTestRange, PO Box 157, WOOMERA SA 5720
  • The Escorted Person is to be escorted by a person who has been granted Approved Person status, who must be able to observe the Escorted Person at all times, for the period within the Exploration Area and Access Routes.
  • The Escorted Person must have in their possession at all times while on the Exploration Area and Access Routes, photographic identification issued by anAustralian Government or State Government body, or an International Passport.
  • The Escorted Person status is valid for a total of 5 days within the 2 year validity status period(whether or not they are consecutive days) after which time an application for Approved Person status should be submitted if required.

PRIVACY STATEMENT

This information is being collected by the Woomera Prohibited Area Coordination Office (WPACO)on behalf of the Department of Defence asauthorisedby theWoomera Prohibited Area Rule 2014.

A copy of the WPACO Privacy Policy is available at and details how personal information is collected, used and stored. The WPACO Privacy Policycontains information on how an individual may apply for access to their personal information and how an individual may apply to have their personal information amended. The Defence Privacy Policy also contains information for individuals on how to make a privacy complaint to Defence if they consider Defence may have breached the Australian Privacy Principles.

W004 NOTIFICATION OF ESCORTED PERSON

Note: All fields are to be answered. If a question is not applicable, enter N/A.

Section 1: APPLICANT DETAILS
Last name
First and Middle name(s)
All other family name(s) used including former married names
Home Address
Suburb/Town/City / State / Postcode
Country
Date of Birth
Place of Birth / City / Country
Current citizenship / Australian / Other (specify):
Other citizenships ever held
Date of arrival in Australia / Date naturalised
Place of naturalisation / Certificate number
Section 2: CURRENT EMPLOYMENT
Employer’s name
Address
Suburb/Town/City / State / Postcode
Country / Telephone (include area code)
Section 3: WPA ACCESS DETAILS(Note: W007 Access Form must also be completed before any proposed instance of access)
Reason for Access
Area to be accessed
Requested date(s) of access / From / To
Requested date(s) of access / From / To
Additional Information:
Section 4:COMPANY SPONSOR DETAILS - Approved Escorting Officer
Last Name
First and Middle name(s)
Date of Birth / Contact Number
Section 5: PHOTOGRAPHIC IDENTIFICATION
Attach copy of Photographic Identification (front and back) to form
Section 6: CERTIFICATION
Applicant: I certify to the best of my knowledge and belief that the information given in this form is correct and complete and that I will notify the Woomera Prohibited Area Coordination Office of any changes in my circumstances.
Signature of Applicant / Printed Name / Date
Permit holder (Note: to be signed by authorised Company Representative)
Signature of Permit holder / Printed Name / Position in Company / Date
Name of Permit holder/s
Woomera Prohibited Area Coordination Office / Page 1 of 2 / W004 Version 1.0