STAATSKOERANT, 9 IUAART 2001 If record is held on computer or in an electronic or machine-readable form . 4. . NO.22125 printed copy of record* - printed copy of copy in computer information derived readable form* from the record* (stiffy or compact i *If you requested a copy or transcription of a record (above), do you disc) YES NO wish the copy or transcription to be posted to you? A postal fee is payable. Note that$the record is not available in the languageyou prefer, access may be granted in the language in which the recordis available. In which language would you prefer the record? .- - -- :1 G. Notice of decisionregardingrequestforaccess to be informed thereof in another manner, please spec@ the manner and provide the 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 ON WHOSE E3EHALF REQUEST IS MADE 13