FORM 2
REQUEST FOR ACCESS TO RECORD[Regulation 7]
NOTE:
1. Proof of identity must be attached by the requester.
2. If requests made on behalf of another person, proof of such authorisation, must be attached to thisform.

TO:

The Information Officer________________________________________________________________________________________(Address)

E-mail address:_____________________________

Fax number:_____________________________Mark with an "X"
Request is made in my own name

Request is made on behalf of another person.

PERSONAL INFORMATION
Full Names
Identity Number
Capacity in which
requestismade(when made on behalfof another person)
Postal Address
Street Address
E-mail Address
Facsimile:

Tel. (B):Contact Numbers
Cellular:
Full names of persononwhosebehalf
request is made (ifapplicable):
Identity Number
Postal Address

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Street Address
E-mail Address
Contact Numbers

Tel. (B)Facsimile

Cellular

PARTICULARS OF RECORD REQUESTED
Provide full particulars of the record to which access is requested, including the reference number ifthat 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. All additional pages must be signed.)

Description of recordor relevant part of therecord:

Reference number, if
available

Any further particularsof record

TYPE OF RECORD(Mark the applicable box with an "X")Record is in written or printed form
Record comprises virtual images (this includes photographs, slides, video recordings,
computer-generated images, sketches, etc)
Record consists of recorded words or information which can be reproduced in soundRecord is held on a computer or in an electronic, or machine-readable form

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FORM OF ACCESS(Mark the applicable box with an "X")Printed copy of record (including copies of any virtual images, transcriptions and information
held on computer or in an electronic or machine-readable form)
Written or printed transcription of virtual images (this includes photographs, slides, video
recordings, computer-generated images, sketches, etc)
Transcription of soundtrack (written or printed document)Copy of record on flash drive (including virtual images and soundtracks)
Copy of record on compact disc drive(including virtual images and soundtracks)
Copy of record saved on cloud storage server

MANNER OF ACCESS(Mark the applicable box with an "X")
Personal inspection of record at registered address of public/private body (including listening
to recorded words, information which can be reproduced in sound, or information held on
computer or in an electronic or machine-readable form)
Postal services to postal address
Postal services to street address
Courier service to street address
Facsimile of information in written or printed format (including transcriptions)E-mail of information (including soundtracks if possible)
Cloud share/file transfer
Preferred language(Note that if the record is not available in the language you prefer, access may be granted in
the language in which the record is available)

PARTICULARS OF RIGHT TO BE 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 tobeexercisedorprotectedPage 3 of 4Explain why the record
requested is required fortheexercise
orprotectionof
theaforementioned right:FEESa)b)c)d)
ReasonA request fee must be paid before the request will be considered.
You will be notified of the amount of the access fee to be paid.
The fee payable for access to a record depends on the form in which access is required andthe reasonable time required to search for and prepare a record.
If you qualify for exemption of the payment of any fee, please state the reason for exemption

You will be notified in writing whether your request has been approved or denied and if approved thecosts relating to your request, if any. Please indicate your preferred manner of correspondence:
Postal address

Electronic communication(Please specify)

Facsimile

Signed at ____________________ this ___________ day of ________________ 20 _________________________________________________________________
Signature of Requester / person on whose behalf request is made-------------------------------------------------------------------------------------------------------------------------------------------FOR OFFICIAL USE
Reference number:
Request received by:(StateRank,NameAndSurname of Information Officer)
Date received:
Access fees:
Deposit (if any):____________________________
Signature of Information Officer

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