a) The Requester must use the prescribed Form C attached to this manual, to make the request for access to a record.
b) The request must be made to the Deputy Information Officer whose contact details are set out in paragraph 4.1(b) above. The completed Form C together with payment of a request fee (if applicable) and a deposit (if applicable) must be sent to the address, fax number or electronic mail address of such Deputy Information Officer set out in paragraph 4.1(b) above.
(c) The Requester must provide sufficient particulars on the request form to enable the Deputy Information Officer to identify the record requested and the Requester. Where the request is made by a personal requester, being a Requester seeking access to records containing their own personal information, the Requester is required to provide an acceptable form of identification such as a certified copy of his / her identity document or any other form of identification acceptable to Telkom.
d) The Requester should also indicate which form of access is required. The Requester should also indicate if he or she wishes to be informed in any other manner and state the necessary particulars to be so informed.
A. Particulars of Public body
The Information Officer/Deputy Information Officer: ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ _____________________________________________________________________
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: _______________________________________________________________ ____
Identity number: ___________________________________________________________________
Postal Address: ________________________________________________________________________ ______________________________________________________________________________________ _____________________________________________________________________Fax Number: __________________________________
Telephone number: __________________________________
E-mail Address: __________________________________
Capacity in which the 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
Full names and surname: _______________________________________________________________ ____
Identity number: ___________________________________________________________________
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 folio and attach it to this form. The requester must sign all the additional folios.
1. Description of record or relevant part of the record: _______________________________________ ______________________________________________________________________________________ _____________________________________________________________________2. Reference number, if available: ________________________________________________________
3. 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 below, state your disability and indicate in which form the record is required.
Disability: ________________________________________ ________________________________________
Form in which record is required: ________________________________________ ________________________________________
Mark the appropriate box with an X.
NOTES:
a) Compliance with your request for access 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 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:
Copy of record
Inspection of record
2. If the record consists of visual images (this includes photographs, slides, video recordings, computer – generated images, sketches, etc.):
View the images Copy of the images Transcription of the images
3. If the record consists of recorded words or information which can be reproduced in sound:
Listen to the soundtrack (audio cassette) Transcription of soundtrack* (written or printed document
4. If the 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 (stiffy 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.
YES NO
G. 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 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? ______________________________________________________________________________________ _____________________________________________________________________Signed at ____________this ______ day of ____________20______
__________________________ SIGNATURE OF REQUESTER / PERSON
FORM 1
OBJECTION TO THE PROCESSING OF PERSONAL INFORMATION IN TERMS OF SECTION 11 (3) OF THE PROTECTION OF PERSONAL INFORMATION ACT, 2013 (ACT NO. 4 OF 2013)
REGULATIONS RELATING TO THE PROTECTION OF PERSONAL INFORMATION, 2018 [Regulation 2]
Note:
1. Affidavits or other documentary evidence as applicable in support of the objection may be attached.
2. If the space provided for in this Form is inadequate, submit information as an Annexure to this Form and sign each page.
3. Complete as is applicable.
A. DETAILS OF DATA SUBJECT
Name(s) and surname/ registered name of data subject:
Unique Identifier/Identity Number
Residential, postal or business address:
Code ( )
Contact number(s):
Fax number/Email address:
B. DETAILS OF RESPONSIBLE PARTY
Name(s) and surname/ registered name of responsible party:
Residential, postal or business address:
Code ( )
Contact number(s):
Fax number/Email address:
C. REASONS FOR OBJECTION IN TERMS OF SECTION 11 (1) (d) to (f)(Please provide detailed reasons for the objection)
Signed at ___________________________ this ______ day of____________20______
_____________________________________
Signature of data subject/designated person
FORM 2
REQUEST FOR CORRECTION OR DELETION OF PERSONAL INFORMATION OR DESTROYING OR DELETION OF
RECORD OF PERSONAL INFORMATION IN TERMS OF SECTION 24 (1) OF THE PROTECTION OF PERSONAL
INFORMATION ACT, 2013 (ACT NO. 4 OF 2013) REGULATIONS RELATING TO THE PROTECTION OF PERSONAL INFORMATION, 2018
Note:
1. Affidavits or other documentary evidence as applicable in support of the request may be attached.
2. If the space provided for in this Form is inadequate, submit information as an Annexure to this Form and sign each page.
3. Complete as is applicable.
Mark the appropriate box with an "x".
Request for:
Correction or deletion of the personal information about the data subject which is in possession or under the control of the responsible party.
Destroying or deletion of a record of personal information about the data subject which is in possession or under the control of the responsible party and who is no longer authorised to retain the record of information.
A. DETAILS OF DATA SUBJECT
Name(s) and surname/ registered name of data subject:
Unique Identifier/Identity Number
Residential, postal or business address:
Contact number(s):
Fax number/Email address:
B. DETAILS OF RESPONSIBLE PATY
Name(s) and surname/ registered name of responsible party:
Residential, postal or business address:
Contact number(s):
Fax number/Email address:
C. INFORMATION TO BE CORRECTED/DELETED/DESTRUCTED/DESTROYED
D. REASONS FOR *CORRECTION OR DELETION OF THE PERSONAL INFORMATION ABOUT THE DATA SUBJECT IN TERMS OF SECTION 24 (1) (a) WHICH IS IN POSESSION OR UNDER THE CONTROL OF THE RESPONSIBLE PARTY; and or REASONS FOR *DESTRUCTION OR DELETION OF A RECORD OF PERSONAL INFORMATION ABOUT THE DATA SUBJECT IN TERMS OF SECTION 24 (1) (b) WHICH THE RESPONSIBLE PARTY IS NO LONGER AUTHORISED TO RETAIN
(Please provide detailed reasons for the request)
Signed at ________________this ______ day of ___________ 20______
__________________________________________
Signature of data subject/designated person