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Objection to the Processing of Personal Information Form

A. Particulars of Data Subject

Name and Surname: Identity Number: Postal Address: Contact Number: Email Address:

B. Details of Responsible Party

Name and Surname / Registered Name: Residential / Postal / Business Address: Contact Number: Fax Number / Email Address:

C. Reasons for Objection in Terms of Section 11(1) (d) to (f)

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