PAIA Form

Request for access to the record of a private body

PAIA Form

Request for access to the record of a private body

Section 53(1) of the Promotion of Access to Information Act, 2000 (Act No. 2 of 2000)

[Regulation 10]

Email for person completing the form:(Required)

A) Particulars of a private body

The Head:(Required)

B) Particulars of person requesting 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 fax number in the Republic 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.

Full names and surname:(Required)

Identity number:(Required)

Postal address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone number:(Required)

Fax number:

E-mail address:(Required)

I am making this request on behalf of another person(Required)

Yes

No

Section (C) will only display if you have checked "yes" for requesting on behalf of another person.

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

C) 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.

Proof of capacity(Required)

Max. file size: 128 MB.

Full names and surname:(Required)

Identity number:(Required)

D) Particulars of record

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.

Description of record or relevant part of the record:(Required)

Reference number, if available:

Any further particulars of record:

E) Fees

a) 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.
b) You will be notified of the amount required to be paid as the request fee.
c) 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 a record.
d) If you qualify for exemption of the payment of any fee, please state the reason for exemption.

Reason for exemption from payment of fees:

F) 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.

Disability:

Please leave this field blank if you do not have a disability.

Form in which record is required:

Check the appropriate box

Notes
a) Compliance with your request in the specified form may depend on the form in which the record is available.
b) 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.
c) The fee payable for access to the record, if any, will be determined partly by the form in which access is requested.

1. If the record is in written or printed form(Required)

Copy of record*

Inspection of record

2. If the record consists of visual images(Required)

(this includes photographs, slides, video recordings, computer-generated images, sketches, etc.)

View the images

Copy of the images*

Transcription of the images*

3. If record consists of recorded words or information which can be reproduced in sound(Required)

Listen to the soundtrack (audio cassette)

Transcription of the soundtrack*

4. If record is held on computer or in an electronic or machine-readable form(Required)

Printed copy of record*

Printed copy of information derived from the record*

Copy in computer readable form* (compact disc)

*If you requested a copy of the transcription of a record (above), do you wish the copy or transcription to be posted to you? (POSTAGE IS PAYABLE)(Required)

Yes

No

G) Particulars of right to be exercised or protected

5. Indicate which right is to be exercised or protected:

6. Explain why the record requested is required for the exercise or protection of the aforementioned right:

H) Notice of decision regarding request for access

You will be notified in writing whether your request has been approved/denied. If you wish to be informed by alternative means, 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 access to the record?

E-mail

Telephone

Post

E-mail address:(Required)

Telephone number:(Required)

Postal Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Document Permissions

Document Signature(Required)

I HEREBY SIGN THIS DOCUMENT ELECTRONICALLY

On this day of this month of this year(Required)

Permission(Required)

I, THE REQUESTOR, HEREBY CONFIRM THAT MY INFORMATION HAS BEEN CORRECTLY CAPTURED AND THAT I CONSENT TO MY INFORMATION BEING SENT TO GROWTHPOINT’S HEAD OF POPIA COMPLIANCE AND LEGAL TEAM.

PAIA Form

Request for access to the record of a private body

PAIA Form

Request for access to the record of a private body

A) Particulars of a private body

B) Particulars of person requesting access to the record

C) Particulars of person on whose behalf request is made

D) Particulars of record

E) Fees

F) Form of access to record

Form in which record is required:

G) Particulars of right to be exercised or protected

H) Notice of decision regarding request for access

Document Permissions

ABOUT

LEGAL

SUPPLIER

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