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:
-