OBJECTION TO THE PROCESSING OF PERSONAL INFORMATION IN TERMS OF SECTION 11 (3) OF THE PROTECTION OF PERSONAL INFORMATION ACT, 2013 (ACT NO. 4 OF 2013)
REGULATIONS RELATING TO THE PROTECTION OF PERSONAL INFORMATION, 2018 [Regulation 2.]
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.
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 REASONS FOR OBJECTION IN TERMS OF SECTION 11 (1) (d) to (f)
(Please provide detailed reasons for the objection)
Signed at this day of 20