Please select the type of request you are making
Rectification / Alteration of Personal Information
Erasure / Deletion of Personal Information
Restriction of processing of Personal Information
Personal Information portability request
Objection to processing Personal Information
Request regarding automated descision making and profiling
1. Particulars of person requesting access to a record
The particulars of the person who requests access to the record must be given below. The address and/or fax number to which the information is to be sent must be given. Proof of the capacity in which the request is made, if applicable, must be attached.
Full names and surname
Identity (ID number or Passport number)
Proof of identity
Capacity in which request is made when made on behalf of another person
2. Particulars of person on whose behalf request is made
This section must be completed ONLY if a request for information is made on behalf of another person.
Full names and surname
Identity or company registration number
Proof of capacity
3. Particulars of record
Provide full particulars of the information or record to which access is requested, including any reference number if that is known to you, to enable the record to be located. If the provided space is inadequate, please continue on a separate page and attach it to this form. The Data Subject Requester must sign all the additional pages.
Description of record or relevant part of the record
Reference number, if available
Any further particulars of record
A request for access to a record, other than a record containing Personal Information about yourself, will be processed only after a request fee has been paid. You will be notified of the amount required to be paid as the request fee. 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 such record. If you qualify for exemption of the payment of any fee, please state the reason for exemption. For a full schedule of fees please view Annexure B of our PAIA Manual
Reason for exemption from payment of fees
5. Form of access to record
If you are prevented by a disability to read, view or listen to the record in the form of access provided for in 1 to 4 hereunder, state your disability and indicate in which form the record is required.
Form in which record is required
Compliance with your request in the specified form may depend on the form in which the record is available.
Access in the form requested may be refused in certain circumstances. In such a case you will be informed if access will be granted in another form.
The fee payable for access to the record, if any, will be determined partly by the form in which access is requested and the time taken to retrieve the record.
1. If the record is in written or printed form
Copy of Record
Inspection of Record
2. If record consists of visual images (this includes photographs, slides, video recordings, computer-generated images, sketches, etc.)
View the images
Copy the images
Transcription of the images
3. If record consists of recorded words or information which can be reproduced in sound
Listen to the soundtrack
Transcription of the soundtrack (Written or printed document)
4. If record is held on computer or in an electronic or machine-readable form
Printed copy of record
Printed copy of information derived from the record
copy in computer readable form (Memory stick or Compact disc)
If you requested a copy or transcription of a record (above), do you wish the copy or transcription to be posted to you? Postage is payable and for your account.
6. Particulars of right to exercised or protected
If the provided space is inadequate, please continue on a separate page and attach it to this form. The Requester must sign all the additional pages.
Indicate which right is to be exercised or protected
Explain why the record requested is required for the exercise or protection of the aforementioned right
Notice of decision regarding request for access
You will be notified in writing via email whether your request has been approved/ denied within 30 days. If you wish to be informed in another manner, please specify the manner and provide the necessary particulars to enable compliance with your request.
How would you prefer to be informed of the decision regarding your request for access to the record?