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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.

DETAILS OF DATA SUBJECT

Name*

Surname*

Unique Identifier/Identiy Number*

Residential, postal or business address:*

Email Address *

Mobile Number*

Fax Number

DETAILS OF RESPONSIBLE PARTY

Name(s) and surname/Registered name of responsible party*

Residential, postal or business address:*

Email Address*

Mobile Number

Fax Number

REASONS FOR OBJECTION IN TERMS OF SECTION 11 (1) (d) to (f) (Please provide detailed reasons for the objection)

Enter reason here*

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