DATA SUBJECT REQUEST FORM

ABOUT THIS FORM

This form lets you exercise your rights under the Protection of Personal Information Act 4 of 2013 (“POPIA”) in a single place. It consolidates the rights set out in:

• Section 23 — your right to know whether we hold personal information about you and to access it;
• Section 24 — your right to have inaccurate, irrelevant, excessive, out-of-date, incomplete, misleading or unlawfully obtained personal information corrected or deleted;
• Section 11(3) — your right to object to processing of your personal information on reasonable grounds, or to processing for direct marketing;
• Section 11(2)(b) — your right to withdraw consent previously given, where processing is based on consent.

You may use this consolidated form, or you may use the prescribed forms attached to our PAIA Manual (Form 1 under POPIA Regulation 2(1) and Form 2 under POPIA Regulation 3(2)). Either is acceptable.

Important. If your request relates to information we hold as Operator for a crèche (for example, your child’s records processed by your child’s crèche through the Kreshe platform), the crèche is the Responsible Party and we are required to refer your request to them. Direct requests to your crèche may be faster.

SECTION A — YOUR DETAILS

Proof of identity. Please attach a clear copy of your ID or passport. We need this to verify it is really you. We will not act on a request without verification.

SECTION B — IF YOU ARE ACTING ON BEHALF OF SOMEONE ELSE

Complete this section if you are submitting the request on behalf of another person (e.g. as parent for your child, or as a representative under power of attorney).

Where the data subject is a child, please attach the child’s birth certificate (or a certified copy) and proof of your parental authority.

SECTION C — WHAT YOU ARE REQUESTING

Please tick all that apply.

☐ C.1 Confirmation and access (POPIA s 23)

I want to know whether Kopanong holds personal information about me (or the person in section B), and to access that information.

Confirmation is free. If access to the information attracts a fee, we will give you a written estimate before proceeding.

Specify the information you want to access (be as specific as you can — date ranges, services used, type of record):

Your description here:

☐ C.2 Correction (POPIA s 24)

I want personal information that you hold about me to be corrected because it is inaccurate, irrelevant, excessive, out of date, incomplete, or misleading.

What needs to be corrected, and to what:

Current information / what it should be:

☐ C.3 Deletion or destruction (POPIA s 24)

I want personal information that you hold about me to be deleted or destroyed.

Tick the applicable ground(s):

☐ The personal information is inaccurate, irrelevant, excessive, out of date, incomplete, misleading or has been unlawfully obtained (POPIA s 24(1)(a))

☐ Kopanong is no longer authorised to retain the record (POPIA s 24(1)(b))

☐ I no longer consent to the processing, and Kopanong has no alternative lawful basis to retain the information (POPIA s 11(2)(b) read with s 14)

☐ The purpose for which the information was collected has been achieved and a longer retention is not required by law or by contract (POPIA s 14(1))

Specify which information:

Description:

☐ C.4 Objection (POPIA s 11(3))

I object to the processing of my personal information in the way described below, on reasonable grounds.

What processing you object to, and why:

Description and grounds:

☐ I specifically object to the processing of my personal information for direct marketing purposes (POPIA s 69).

☐ C.5 Withdrawal of consent (POPIA s 11(2)(b))

Where processing is based on my consent, I withdraw that consent.

Specify what consent you are withdrawing:

Description:

Note: Withdrawal of consent does not affect the lawfulness of processing carried out before the withdrawal. Where we have a separate lawful basis for processing (e.g. a legal obligation, a contract, or a legitimate interest), we may continue processing on that basis and will let you know.

SECTION D — REASONS AND SUPPORTING DOCUMENTS

(Optional but helpful — providing context speeds up our response.)

Any further reasons, context or supporting documents:

Documents attached:

☐ Proof of identity (mandatory)

☐ Proof of authority (if acting on behalf of another)

☐ Affidavit (where appropriate, for s 11(3) objections or s 24 correction/deletion requests — recommended where the request is contested)

☐ Other (specify):

SECTION E — DECLARATION AND SIGNATURE

Please note that any attempt to mislead Kopanong in this form may result in prosecution under section 107 of POPIA, section 90 of PAIA, or any other applicable law.

I confirm that:

(a) I have read and understood the terms of this form;

(b) the information I have provided in this form, and any documents attached, is true and correct;

(c) where I am acting on behalf of another data subject, I have the authority to do so and have attached proof of that authority;

(d) I understand that Kopanong is required to verify my identity (and, where applicable, the data subject’s identity) before acting on this request, and may require additional information to do so; and

(e) I understand that, where the request relates to information held by Kopanong as Operator on behalf of a crèche, Kopanong will refer the request to the relevant crèche as Responsible Party.

Signed at: __________________________

On: ______________________________

Signature of requester / data subject: ______________________________

WHAT HAPPENS NEXT

1. We will acknowledge receipt of your request, usually within 5 business days.

2. We will verify your identity. We may ask for additional proof if what you have given us is not sufficient.

3. We will respond to your request within 30 days, unless we reasonably need more time and have notified you of the extension.

4. If we cannot give effect to your request, we will tell you why, in writing, and explain your right to:

   • lodge a complaint with the Information Regulator at complaints.IR@inforegulator.org.za; or
   • apply to a competent court.

OUR INFORMATION OFFICER

This form is published in compliance with sections 11, 23 and 24 of the Protection of Personal Information Act 4 of 2013, and the POPIA Regulations. It supplements, but does not replace, the prescribed forms in the POPIA Regulations, which remain available on request.

FOR INTERNAL USE ONLY

To be completed by Kopanong’s Information Officer.

Signature of Information Officer

Date: _______________