Part A - Particulars of the Information Seeker

Part B - Particulars of Person on Whose Behalf the Request is Made (To be completed if a request is submitted on behalf of another person)

Part C - Summary of Request

Provide a summary of your request for information and why the information should be provided to you. Give reasons why you disagree with the decision of the information officer.

Part D - Type of Assistance Requested

Describe the type of assistance that you are looking for from the Head of the Institution to whom the request for information was addressed.

Attachments (Optional)

Attach copies of the following documents if available:

• 1. The request for information Form
• 2. The information officer's response to the request for access to information