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 41 A. Particulars of private body The Head: B. (a) Particulars of personrequesting access tothe record n e particulars of the person who requests access to the record must be recorded beio w. (b) Furnish an address a d o rfanumber in the Republic to which information must be sent. (c) proof of the capacity in which the request is made, ifapplicable, must be attached Full names and surname: Identity number: Postal address: - Fax number: __ Telephone number: - E-mail address: ~ Capacity in which request is made, when made on behalf of another person: