VIC Request Form

This VIC Request Form is designed to facilitate a quicker approval process. Applicants who, in the opinion of the Airport Reporting Officer (ARO), do not have legitimate operational need for airside access will be refused access. The applicant and their supervising ASIC holder (if known) will need to be present in person at the airport office with proof of identification (Driver's License or Passport) prior to a VIC pass being issued. VIC passes will only be issued during business hours Monday to Friday or as otherwise agreed by the ARO. The ARO must be contacted on 0428 935 618 to arrange a time for VIC pass collection.

First Name*

Middle Name

Surname*

Company Represented

Date of Birth*

Address*

Phone Number*

Reason for requiring VIC Pass*

Date From*

Date To*

Proof of Identification*

Supervising ASIC Holder

Collection Notice

By submitting this form, you acknowledge that the Shire of Esperance collects and uses personal information for the purpose of administering its services and functions such as maintaining accurate records, and meeting legal, reporting, and governance obligations. For more information about how we collect, use, and store personal information, please refer to our Privacy Policy.

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VIC Request Form

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