Application Form for Prior Authorisation

NOTE: The personal information submitted herein shall be solely used for purposes of prior authorisation application submitted to the Information Regulator (“Regulator”) in terms of section 58(1) of the Protection of Personal Information Act, 2013 (POPIA).

All the information submitted herein shall be used for the purpose stated above, as mandated by the law. This Information may be disclosed to the public. The Regulator undertakes to ensure that appropriate security control measures are implemented to protect all the personal information to be submitted in this document.