REQUEST FOR CORRECTION OR DELETION OF PERSONAL INFORMATION OR DESTROYING OR DELETION OF RECORD OF PERSONAL INFORMATION IN TERMS OF SECTION 24 (1) OF THE PROTECTION OF PERSONAL INFORMATION ACT, 2013 (ACT NO. 4 OF 2013)

REGULATIONS RELATING TO THE PROTECTION OF PERSONAL INFORMATION, 2018 [Regulation 3.]

Note:

1: Affidavits or other documentary evidence as applicable in support of the objection may be attached

2: If the space provided for in this Form is inadequate, submit information as an Annexure to this Form and sign each page.

3: Complete as is applicable.

Check the appropriate box:

Correction or deletion of the personal information about the data subject which is in possession or under the control of the responsible party.

Destroying or deletion of a record of personal information about the data subject which is in possession or under the control of the responsible party and who is no longer authorised to retain the record of information.

A	DETAILS OF DATA SUBJECT
Name(s) and surname/registered name of data subject:
Unique Identifier/Identiy Number:
Residential, postal or business address:
Contact number(s):
Fax number/E-mail address:
B	DETAILS OF RESPONSIBLE PARTY
Name(s) and surname/Registered name of responsible party:
Residential, postal or business address:
Contact Number(s):
Fax number/E-mail address:
C	INFORMATION TO BE CORRECTED/DELETED/ DESTRUCTED/ DESTROYED

D	REASONS FOR CORRECTION OR DELETION OF THE PERSONAL INFORMATION ABOUT THE DATA SUBJECT IN TERMS OF SECTION 24 (1) (a) WHICH IS IN POSSESSION OR UNDER THE CONTROL OF THE RESPONSIBLE PARTY; and or REASONS FOR DESTRUCTION OR DELETION OF A RECORD OF PERSONAL INFORMATION ABOUT THE DATA SUBJECT IN TERMS OF SECTION 24 (1) (b) WHICH THE RESPONSIBLE PARTY IS NO LONGER AUTHORISED TO RETAIN (Please provide detailed reasons for the request)

Signed at

this

day of