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ANNEXURE A   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 10]   Particulars of private bodyThe Head: PRICESURE CCB.           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 request is made, when made on behalf of another person: ……………………………   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: ………………………………………………………………………………………………………   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.   Description of record or relevant part of the record: Reference number, if available: Any further particulars of record:   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.   Reasons for exemption from payment of fees:   ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………   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 hereunder, 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 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 a 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 record consists of visual images:    (this includes photographs, slides, video recordings, computer-generated images, sketches etc.) View images Copy of images* Transcription of images* 3. If record consists of recorded words or information which can be reproduced in sound: Listen to soundtrack (audio cassette) Transcription of soundtrack* (written or printed document) 4. if record is held on computer or in an electronic or machine-readable form: Printed copy* Printed copy of information derived from 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 be posted to you?                                                   YES NO Postage is payable   Particulars of right to be exercised or protected   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.   Indicate which right is to be exercised or protected: Explain why the record requested is required for the exercise or protection of the aforementioned right:   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 ON WHOSE BEHALF REQUEST IS MADE ANNEXURE B   Fees in respect of private bodies   The fee for a copy of the manual as contemplated in regulation 9(2)(c) is R1, 10 for every photocopy of an A4-size page or part thereof.   The fees for reproduction referred to in regulation 11(1) are as follows: R (a)        For every photocopy of an A4-size page or part thereof                                                                              1,10 (b)        For every printed copy of an A4-size page or part thereof held on a computer or in electronic or machine- readable form                                                                           0,75 (c)        For a copy in a computer-readable form on – (i) stiffy disc                                                                              7,50 (ii) compact disc                                                                        70,00 (d)        (i) For a transcription of visual images, for an A4-size page or part thereof                                             40,00 (ii) For a copy of visual images                                                  60,00 (e)        (i) For a transcription of an audio record, for an A4-size page or part thereof                                             20,00 (ii) For a copy of an audio record                                               30,00   The request fee payable by a requester, other than a personal requester, referred to in regulation 11(2) is R50,00.   The access fees payable by a requester referred to in regulation 11(3) are as follows: R (1)(a)   For every photocopy of an A4-size page or part thereof                                                                              1,10 (b)        For every printed copy of an A4-size page or part thereof held on a computer or in electronic or machine- readable form                                                                           0,75 (c)        For a copy in a computer-readable form on – (i) stiffy disc                                                                              7,50 (ii) compact disc                                                                        70,00 (d)        (i) For a transcription of visual images, for an A4-size page or part thereof                                             40,00 (ii) For a copy of visual images                                                  60,00 (e)        (i) For a transcription of an audio record, for an A4-size page or part thereof                                             20,00 (ii) For a copy of an audio record                                               30,00 (f)        To search for and prepare the record for disclosure, R30,00 for each hour or part of an hour reasonably required for such search and preparation.   (2)        For purposes of section 54(2) of the Act, the following applies: (a) Six hours as the hours to be exceeded before a deposit is payable; and (b) one third of the access fee is payable as a deposit by the requester.   (3)        The actual postage is payable when a copy of a record must be posted to a requester.
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