B. (a) Particularsof person requesting access to the record ne particulars of the person who requests acct’ss to the record must be recorded below. (b) Furnish an address andor f a r number in the Republic to which information must be sent. (c) Proof of the capacity in which the request is made, (fapplicable,must be attached. Full names and surname: Identity number: Postal address: Fax number: E-mail address: Telephone number: Capacity in which request is made, when made on behalf of another person: C. Particulars of person on whose behalf request Lq made This section must be completedonly ifa request for information is Made on beharfof anotherpenon. Full names and surname: Identity number: -