Request for Access to Record (PAIA Form C)

Updated: 23 August 2025

This form is prescribed under section 53(1) of the Promotion of Access to Information Act 2 of 2000 (PAIA) to request access to a record held by Noiz, a private body. Please complete all relevant sections and submit the form to our Information Officer as detailed below. Ensure you provide sufficient information to enable us to identify the requested record(s) and process your request in accordance with PAIA.

Contents

Submission Instructions

Complete this form and submit it to the Noiz Information Officer via:

  • Email: legal@noiz.ie
  • Postal Address: [Insert Postal Address]
  • Fax: [Insert Fax Number, if applicable]

Ensure you include all required details and any applicable fees, as outlined in the Fees section. For guidance, refer to our Access to Information Manual or contact the South African Human Rights Commission (SAHRC) at section51.paia@sahrc.org.za.

Particulars of Private Body

The particulars of the private body from which the record(s) are requested are:

  • Name of Private Body: Noiz (Pty) Ltd
  • Registration number: [INSERT NOIZ COMPANY REGISTRATION NUMBER HERE]
  • Information Officer: [Insert Name]
  • Email: legal@noiz.ie
  • Postal address: [Insert Postal Address]
  • Physical address: [Insert Physical Address]
  • Phone number: [Insert Phone Number]
  • Fax number: [Insert Fax Number, if applicable]

Particulars of Requester

If you are requesting access to a record on your own behalf, please provide the following details:

Surname [Provide your surname]
First name(s) [Provide your first name(s)]
Identity number [Provide your identity number]
Postal address [Provide your postal address]
Physical address [Provide your physical address]
Phone number [Provide your phone number]
Fax number [Provide your fax number, if applicable]
Email address [Provide your email address]

Particulars of Person on Whose Behalf Request is Made

If you are requesting access on behalf of another person, please provide their details and your capacity to act on their behalf:

Surname [Provide their surname]
First name(s) [Provide their first name(s)]
Identity number [Provide their identity number]
Your capacity [e.g., Attorney, Guardian, Agent]

Particulars of Record

Provide full particulars of the record(s) to which access is requested, including the reference number if known, to enable the record to be located. If the space provided is inadequate, attach an annexure and indicate this below.

Description of record or relevant part [Describe the record or part thereof, e.g., “Customer account details for [Account Number]”]
Reference number, if available [Provide reference number, if known]
Any further particulars [Provide additional details to locate the record]
Annexure attached? [Yes/No; if Yes, specify details]

Fees

A request fee must be paid before the request will be considered, as prescribed by PAIA Regulations. You will be notified of the amount, which must be paid to Noiz. Additionally, an access fee may be required for the time spent searching for and preparing the record(s), as permitted by law. If you qualify for an exemption from any fee, please provide the reason:

Reason for exemption [State reason, e.g., “Public interest” or “Financial hardship”]

Form of Access

Indicate the form in which you require access to the record(s) by marking the appropriate box with an X. Note that some forms may incur additional costs, and access may be limited to the form in which the record is held if your request is not approved for a specific form.

Form Mark with X
Printed copy of record (including copies of any part) [ ]
Copy of record on compact disc (e.g., scanned PDF) [ ]
Copy of record on USB or memory stick [ ]
Inspection of record only [ ]
Transcription of images (e.g., scanned documents to text) [ ]
Transcription of audio (e.g., typed copy of audio record) [ ]
Copy of images or audio on compact disc or USB [ ]

If the record is not in written or visual form (e.g., audio), indicate your preferred manner and form of access:

Preferred manner/form [Specify, e.g., “Digital audio file on USB”]

If you have a disability preventing you from accessing the record in the forms above, state your disability and preferred form of access:

Disability [Specify, e.g., “Visual impairment”]
Preferred form of access [Specify, e.g., “Braille transcription”]

Particulars of Right to be Exercised or Protected

If the request is made on behalf of another person or for the exercise/protection of a right, indicate the nature of the right and why the record is required:

Right to be exercised/protected [Describe, e.g., “Right to privacy”]
Why record is required [Explain, e.g., “To verify data accuracy for legal proceedings”]

Notice of Decision

You will be notified in writing whether your request has been approved or denied within the statutory timeframe prescribed by PAIA. If approved, we will provide details on how access will be granted and any applicable access fees. If denied, we will provide reasons, subject to PAIA. For inquiries, contact our Information Officer at legal@noiz.ie.