REQUEST FOR ACCESS TO RECORD OF PRIVATE BODY
(Section 53(1) of the Promotion of Access to Information Act, 2000 (Act No. 2 of 2000))

[Regulation 41
A.

Particulars of private body

The Head:

B.

(a)

Particulars of personrequesting access tothe record

n e particulars of the person who requests access to the record must be recorded

beio w.
(b)

Furnish an address a d o rfanumber in the Republic to which information must

be sent.
(c)

proof of the capacity in which the request is made, ifapplicable, must be attached

Full names and surname:
Identity number: Postal address:

-

Fax number: __
Telephone number:

- E-mail address:

~

Capacity in which request is made, when made on behalf of another person:

Select target paragraph3