Obj to process info

Objection to the processing of personal information in

terms of Section 11(3) of The Protection of Personal Information Act, 2013:

Regulation relating to The Protection of Personal Information, 2018

Note:

Affidavits or other documentary evidence as applicable in support of the objection may be attached
If the space provided for in this form is inadequate, submit information as an Annexure to this form and sign
Complete as is applicable

Section A: Details of data subject

Name(s) and surname / registered name of data subject

Unique Identifier / Identity Number

Residential, postal or business address

Contact number(s)

E-mail address

Fax number

Section B: Details of responsible party

Name(s) and surname / registered name of responsible party

Residential, postal or business address

Contact number(s)

E-mail address

Fax number

Section C: Reasons for objection in terms of Section 11(1)(d) to (f)

(Please provide detailed reasons for objection)

Section D: Attachments and Signature

Affidavits or other documents

Upload any supporting documents as referred to in point 1 above Files must be less than 2 MB. Allowed file types: gif jpg jpeg png txt pdf doc docx.
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png.

Annexure

Upload any supporting documents as referred to in point 2 above Files must be less than 2 MB. Allowed file types: gif jpg jpeg png txt pdf doc docx.
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png.

Date of Signature

Year

Month

Day

Electronically signed

(Please type in your full name)

Leave this field blank