Phau Ntawv Qhia

TITLE:
PAIA and POPIA Manual
DOC No:
DMSA-PAIA/POPIA-01
REV:
00
Page 12 of 16
Annexure A: PAIA FORM C
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 10
A. Particulars of a Private Body
B. Particulars of the person who requests access to the record
(a) The particulars of the person who requests access to the record must be given below.
(b) The address and/or e-mail address in the Republic of South Africa to which the information is to be
sent must be given.
(c) Proof of the capacity in which the request is made, if applicable, must be attached.
C. Particulars of person on whose behalf the request is made
(This section must be completed ONLY if a request for information is made on behalf of another
person)
D. Particulars of record
(a) Provide full particulars of the record to which access is requested, including the reference
number if that is known to you to enable the record to be located.
(b) 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.
1. Description of record or relevant part of the record:
Full Names and Surname
Identity Number
Postal Address
E-mail Address
Telephone Number
Capacity in which request is made on behalf of another person:
Full Names and Surname
Identity Number