45

C. Declaration

Privacy Notice: Once deemed valld, your Information from your appllcatlon wlll be used by the agency
you have applied to, to deal with your applicatlon as set out In the Freedom of Information Executive Order
No. 2. If the Department or Agency gives you access to a document, and If the document contains no per­
sonal Information about you, the document wlll be published onllne In the Department's or Agency's dlsclo­
sure log, along with your name and the date you applied, and, If another person, company or body wlll use
or benefit from the documents sought, the name of that person,entlty or body.

I declare that:
• The information provided in the form is complete and correct;
• I have read the Privacy notice;
• I have presented at least one (1) government-issued ID to establish proof of my identity

I understand that it is an offense to give misleading information about my identity, and that doing so may
result in a decision to refuse to process my application.

Signature ... __ _ _ _ _ _ _ _ _ _ _ _
_

Date Accomplished (DD/MM/YYYYJ ... __ _ _ _ _ _ _ _ _ _ _ _

_

D. FOi Receiving Officer [INTERNAL USE ONLY]

Name (Print name) ... -------------------------------

Agency - Connecting Agency (if
applicable, otherwise NIA) ..._______ ___
_ _ _
_ ... ______________
Date entered on eFOI (if applicable,
otherwise NIA)
... _________________
Proof of ID Presented (Photocopies of D Passport D Driver's License D SSS ID D Postal ID D Voter's ID
original should be attached)
D School ID D Company ID D Others
The request is recommended to be: D Approved D Denied
If Denied, please tick the Reason for the
Denial D Invalid Request D Incomplete D Data already available online

Second Receiving Officer Assigned

(print name)
... _______________________________
Decision Maker Assigned to ... - - ----------------------------
-
Application (print name)

Decision on Application D Successful D Partially Successful D Denied D Cost

If Denied, please tick the Reason for the D Invalid Request D Incomplete D Data already available online
Denial
D Exception Which Exception? ---------------

Date Request Finished (DDIMMIYYYY) .,.

________________
Date Documents (if any) Sent
(DD/MM/YYYY)
... -----------------
FOi Registry Accomplished 0Yes 0No

RO Signature ... _
_____________________________
_

Date (DD/MM/YYYYJ ... _________________

IR!ll)0,\101 INIORMAIION