Correspondence Address ___________________________________________________
Tel. No. __________________________ Email Address __________________________
Fax No. __________________________
* Please delete as appropriate
# Complete only if the applicant's personal data are required
To : Access to Information Officer
(Name of department)
Details of information requested (Please be as specific as possible. It will help us understand clearly the information you are seeking. Use a separate sheet if necessary.)
Signature ______________________________ Date____________________________
1. A charge reflecting the cost of reproducing the records concerned may be levied. The department will advise you in advance of any such charge.
2. You may be asked to provide additional information to help us meet your request. The department may not be able to process your application if you do not provide sufficient information.
3. The information provided will be used for processing your application for access to information. It may be divulged to other departments/agencies for the same purpose.
4. For correction of or access to personal data contained in this application, please contact the Access to Information Officer of the department concerned.
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