Version 1.0 | Effective Date: 7 October 2026
Complete this form and email it to paia@orbio.africa. To keep a copy, use your browser's print function (Ctrl+P) and choose "Save as PDF". We will acknowledge your request within 5 business days and respond within 30 calendar days. See the PAIA Manual for applicable fees, response timeframes, and the grounds on which access may be refused.
Full name: ______________________________________________________________
Identity / passport number: ____________________________________________
Physical address: _____________________________________________________
Postal address: _______________________________________________________
Telephone: ____________________________ Email: _____________________________
☐ I am acting on my own behalf. ☐ I am acting on behalf of another person (attach written authority and that person's identity).
☐ I am an agent of a juristic person (specify entity and capacity): ____________________________
Describe the record as clearly as possible (subject matter, date range, format):
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Purpose of request: _____________________________________________________
☐ Copy ☐ Inspection ☐ Statement of the record ☐ Transcription
Preferred delivery: ☐ Email (PDF) ☐ Postal service ☐ In person
I understand that fees may apply in terms of section 52 of PAIA (request fee R50; search and retrieval R150 per hour; copies R2 per A4 page black & white and R10 per A4 page colour), payable in advance once a fee estimate is provided, and that access to a record may be refused only on the grounds listed in section 62 of PAIA.
Signature: ________________________________________ Date: ______________________
Date received: ____________________ Reference number: ______________________
Acknowledged (5 business days): ______________ Decision due (30 days): ______________
Decision: ☐ Access granted ☐ Access refused (reasons attached) ☐ Partially granted