ANNEXURE B IN TERMS OF NOTICE 187 OF GOVERNMENT GAZETTE OF 15 FEBRUARY 2002
NOTICE OF INTERNAL APPEAL
(Section 75 of the Promotion of Access to Information Act, 2000 (Act No. 2 of 2000))
A. Appeal record
NOTE: A person who lodges an internal appeal may have to pay an appeal fee.
If an appeal fee is payable, the decision of the internal appeal may be deferred until the fee is paid.
B. Particulars of public body
The Information Officer / Deputy Information Officer
C. Particulars of requester/third party who lodges the internal appeal
(a) The particulars of the person who is lodging the internal appeal, must be completed below.
(b) Proof of the capacity in which appeal is lodged, if applicable, must be attached.
(c) If the appellant is a third person and not the person who originally requested the information, the particulars of the requester must be stated at D below.
Full names and surname
Capacity in which an internal appeal on behalf of another person is lodged
D. Particulars of requester
This section must be completed ONLY if a third party (other than the requester) is lodging the internal appeal
Full names and surname
E. The decision against which the internal appeal is lodged
Select the decision against which the internal appeal is lodged in the appropriate box
Refusal of request for access
Decision regarding fees determined in terms of section 22 of the Act
Decision regarding the extension of the period within which request must be dealt with in terms of section 26(1) of the Act
Decision in terms of section 29(3) of the Act to refuse access in the form as requested by the requester
Decision to grant request for access
F. Grounds for appeal
IF THIS FORM IS PRINTED OUT AND SUBMITTED MANUALLY:
If the provided space is inadequate please continue on a separate folio and attach it to this form. You must sign all the additional folios.
If attachments need to be send electronically, please forward it via email to email@example.com and quote the Reference Number.
State the grounds upon which the internal appeal is based
State any other information that may be relevant in considering the appeal
G. Notice of decision on appeal
You will be notified in writing of the decision on your internal appeal.
If you wish to be informed thereof in another manner, please specify the manner and provide the necessary particulars to enable compliance with your request.
State the manner
Particulars of manner
this 21 May 2013
Full name of appellant
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