FORM 2
REQUEST FOR ACCESS TO RECORD [Regulation 7] Note: 1. Proof of identity must be attached by the requester. 2. If requests made on behalf of another person, proof of such authorisation, must be attached to this form.

Requester Information Full Name: Identity Number: Capacity (if on behalf of another): Postal Address: Street Address: Email Address: Telephone: Facsimile: Cellular:

Record Requested Description of Record: Reference Number: Further Particulars:

Type of Record

Written or Printed Form

Virtual Images

Sound Recordings

Electronic Format

Form of Access

Printed Copy

Transcription

Flash Drive

Compact Disc

Cloud Storage

Manner of Access

Personal Inspection

Postal Services

Courier Service

Facsimile

Cloud Share

Preferred Language:

Particulars of Right to be Exercised or Protected Indicate which Right is to be excercised or protected: Explain why the record requested is required for the exercise or protection of the aforementioned right:

Fees

a) A request fee must be paid before the request will be considered.
b) You will be notified of the amount of the access fee to be paid.
c) The fee payable for access to a record depends on the form in which access is required and the reasonable time required to search for and prepare a record.
d) If you qualify for exemption of the payment of any fee, please state the reason for exemption.

Fee Exemption Reason:

Preferred Correspondence Postal Address: Fax: Email:

Identity

1. Proof of identity must be attached by the requester.

Paste identity proof here:

Or upload proof of identity / authorisation:

Authorisation Supporting Documents

2. Requests being made on behalf of another person, Please attach proof of such authorisation.

Signature

Signed at this

Signature (paste text):

Or upload a signature image:

FORM 2 REQUEST FOR ACCESS TO RECORD [Regulation 7] Note: 1. Proof of identity must be attached by the requester. 2. If requests made on behalf of another person, proof of such authorisation, must be attached to this form.

FORM 2
REQUEST FOR ACCESS TO RECORD [Regulation 7] Note: 1. Proof of identity must be attached by the requester. 2. If requests made on behalf of another person, proof of such authorisation, must be attached to this form.