APPENDIX A
ACCESS REQUEST FORM
Reference Number:
Received by:
(Section 53(1)(e) of the Promotion of Access to Information Act, 2000 (Act No. 2 of 2000))
[Regulation 10]
1PARTICULARS OF BODY
Requests can be submitted either via conventional mail or fax and should be addressed to the relevant contact person as indicated below:
MR PRICE GROUP LIMITED
Contact person: Mrs Helen Ellis Grosvenor
Postal address: PO Box 912, Durban 4000
Physical address: Upper Level, North Concourse, 65 Masabalala Yengwa Avenue, Durban 4001
Telephone number: +27 31 310 8000
Fax number: |
+27 31 304 3725 |
E – mail : |
hgrosvenor@mrpricegroup.com |
Website : |
www.mrpricegroup.com |
2a PARTICULARS OF REQUESTER (If Natural Person)
(a)Particulars of the person who requests access to the record must be recorded below.
(b)Furnish an address and/or fax number in the Republic to which information must be sent.
(c)Proof of the capacity in which the request is made, if applicable, must be attached.
Full names and surname: ___________________________________________________________
__________________________________________________________________________________
Identity number:
Postal address: ____________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Postal code: ________________
Phone number: (__________)________________________________________________________
Fax number: (__________)________________________________________________________
E-mail address: ___________________________________________________________________
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Capacity in which request is made, when made on behalf of another person: _________________
___________________________________________________________________________________
2b PARTICULARS OF REQUESTER (if a Legal Entity)
(a)Particulars of the entity that requests access to the record must be recorded below.
(b)Furnish an address and/or fax number in the Republic to which information must be sent.
(c)Proof of the capacity in which the request is made, if applicable, must be attached.
Name of entity: _____________________________________________________________________
___________________________________________________________________________________
Registration number: _______________________________________________________________
Postal address: ____________________________________________________________________
___________________________________________________________________________________
Postal Code: ____________________
Phone number: (_________)__________________________________________________________
Fax number: (_________)__________________________________________________________
3PARTICULARS OF PERSON ON WHOSE BEHALF REQUEST IS MADE
This section must ONLY be completed if a request for information is made on behalf of another person.
Full names and surname: ___________________________________________________________
__________________________________________________________________________________
Identity number:
4PARTICULARS OF RECORD
(a)Provide full particulars of the record to which access is requested, including the reference number if it 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: ______________________________________________________
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Any further particulars of record: _____________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
5FEES
(a)A request for access to a record, other than a record containing personal information about yourself, will be processed only after a non-refundable request fee of R57.00 has been paid.
(b)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 the record.
(c)You will be notified of the amount required to be paid as the access fee.
(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: ___________________________________________
__________________________________________________________________________________
6a FORM OF ACCESS TO RECORD 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 under certain circumstances. In such a case, you will be informed whether 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* |
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Inspection of record |
|
|
|
2.If record consists of visual images:
(this includes photographs, slides, video recordings, computer-generated images, sketches, etc.)
Copy of the images* |
|
Transcription of the images* |
|
|
|
|
3. If the record consists of recorded information that can be reproduced in sound:
Listen to the soundtrack (audio cassette)
Transcription of soundtrack* (written or printed document)
Page 4 of 5
4.If the record is held on computer or in an electronic or machine-readable form:
(this includes photographs, slides, video recordings, computer-generated images, sketches, etc.)
Printed copy of record* |
|
Printed copy of |
|
Copy in computer readable |
|
|
|
|
Information derived |
|
form* (stiffy or compact disc) |
|
|
from the record* |
|
|
*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.
6b In the event of disability
If you are prevented by a disability from reading, viewing or listening to the record in the form of access provided for in 1 to 4 above, state your disability and indicate the form in which the record is required.
Disability: _________________________ Form in which record is required: _____________
__________________________________ ___________________________________________
__________________________________ ___________________________________________
7PARTICULARS OF RIGHT TO BE EXERCISED OR PROTECTED
If the space provided is inadequate, please continue on a separate folio and attach it to this form.
The requester must sign all additional folios.
1.Indicate the right to be exercised or protected: ____________________________________
_____________________________________________________________________________
_____________________________________________________________________________
2.Explain why the record requested is required for the exercise or protection of the aforementioned right: __________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
8NOTICE 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? ________________________________________________________________________
________________________________________________________________________________
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Signed at_________________________this__________day of________________________ 20_________
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____________________________________ |
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SIGNATURE OF REQUESTER/PERSON |
|
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ON WHOSE BEHALF REQUEST IS MADE |
YOU MUST: |
SEND WITH THIS APPLICATION: |
1. |
Complete all necessary spaces. |
1. |
R57.00 (if not personal requester) request |
|
|
|
fee . |
2. |
Sign the access request form. |
|
|
3. |
Sign additional folios completed. |
2. |
Any additional folios completed. |
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APPENDIX B
PRESCIBED FEES
(Section 54(7) of the Promotion of Access to Information Act, 2000 (Act No. 2 of 2000))
[Regulation 11 (3)]
1PLEASE NOTE THAT ALL PRICES LISTED BELOW ARE INCLUSIVE OF VALUE-ADDED TAX (VAT)
(a)For every photocopy of an A4-size page or part thereof
(b)For every printed copy of an A4-size page of part thereof held on a computer or in an electronic or machine-readable form
(c)For a copy in a computer-readable form on
(i)stiffy disc
(ii)compact disc
(d)(i) For a transcription of visual images, for an A4-size page or part thereof
(ii)For a copy of visual images
(e)(i) For a transcription of an audio record, for an A4-size page or part thereof
(ii)For a copy of an audio record
(f)To search for and prepare the record for disclosure – R34.20 for each hour or part thereof reasonably required for such search and preparation.
R1.25
R0.85
R8.55
R79.80
R45.60
R68.40
R22.80
R34.20
[Section 54(2) of the Promotion of Access to Information Act, 2000 (Act No. 2 of 2000)]
[Regulation 11 (3)]
2PLEASE NOTE THAT ALL PRICES FOR THE ITEMS LISTED BELOW ARE INCLUSIVE OF VALUE-ADDED TAX (VAT)
(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.
[Section 54(7) of the Promotion of Access to Information Act, 2000 (Act No. 2 of 2000)]
[Regulation 11 (3)]
3PLEASE NOTE THAT THE PRICE FOR THE ITEMS LISTED BELOW IS INCLUSIVE OF VALUE-ADDED TAX (VAT)
The actual postage fee is payable when a copy of a record must be posted to a requester.
ADDITIONAL PRESCRIBED INFORMATION
The Minister of Justice has prescribed no additional information.
End of Document
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